Effect of glycylpressin on the intravascular oesophageal variceal pressure (IOVP) in patients with liver cirrhosis and previous bleeding

E F F E C T OF G L Y C Y L P R E S S I N ON THE I N T R A V A S C U L A R O E S O P H A G E A L V A R I C E A L P R E S S U R E (IOVP) IN PATIENTS WITH LIVER C I R R H O S I S AND PREVIOUS BLEEDING M. Staritz, A. Rambow, M e y e r zum B~schenfelde, K.H. 1st D e p a r t m e n t of Medicine, U n i v e r s i t y of Mainz, D-6500 Mainz, FRG D e s p i t e r e m a r k a b l e side effects g l y c y l p r e s s i n is c o m m o n l y used for medical t r e a t m e n t of acute v a r i c e a l bleeding. C l i n i c a l trials y i e l d i n g c o n f l i c t i n g results caused doubt w h e t h e r the drug r e a l l y d e c r e a s e s portal pressure. The aim of our study was to i n v e s t i g a t e the effect of g l y c y l p r e s s i n onto the IOVP. Methods: 15 p a t i e n t s with h i s t o l o g i c a l l y p r o v e n liver c i r r h o s i s (Child's A) and p r e v i o u s v a r i c e a l h a e m o r r h a g e were included. 8 p a t i e n t s p r e s e n t i n g the o e s o p h a g e a l v a r i c e s grade I/II/III (n=i/6/l) had p r e v i o u s s c l e r o s i n g therapy b e f o r e bleeding, 7 p a t i e n t s had not (varices grade I / I I / I I I = i / 5 / l ) . The IOVP was m e a s u r e d e n d o s c o p i c a l l y by fine needle p u n c t u r e (Gut 1 9 8 5 , 2 6 : 5 2 5 - 5 3 0 ) b e f o r e and i0 m i n u t e s after i.v. a d m i n i s t r a t i o n of 1 mg g l y c y l p r e s s i n . Results: IOVP was d e c r e a s e d in p a t i e n t s w i t h o u t p r e v i o u s s c l e r o s i n g therapy from 21.8 ~ 2.8 to 19.0 ± 1.9 mmHg (n.s.) and in those p r e v i o u s l y s c l e r o s e d from 18.0 + 1.4 to 14.5 Z 1.0 mm Hg (p< 0.05), respectively. In two out of the n o n s c l e r o s e d p a t i e n t s and in one s c l e r o s e d no change of IOVP was recorded. D is c u s s i o n : In 8 out of 15 p a t i e n t s with liver c i r r h o s i s and p r e v i o u s v a r i c e a l b l e e d i n g g l y c y l p r e s s i n did not lower the IOVP. In the r e m a i n i n g 7 i n d i v i d u a l s the drug showed only minor effect. The results induced that g l y c y l p r e s s i n has minor and u n c e r t a i n effect on the i n t r a v a s c u l a r o e s o p h a g e a l v a r i c e a l pressure. In view of the p o s s i b l e side effects of the drug the i n d i c a t i o n for its use should be w e i g h e d carefully.

DUPLEXSONOGRAPHY OF THE PORTAL VEIN: A RELIABLE, NON INVASIVE APPROACH TO DIAGNOSE PORTAL HYPERTENSION ?

M.Staritz, P.Schiedermeier, A.Rambow, P. Mildenberger, M.Thelen, Meyer zum B~schenfelde,K.H., I. Med. Depart. and Depart. of Radiology, University Mainz, D-6500 Mainz, FRG To date diagnosis and particularly classification of portal hypertension require invasive procedures. Since the reproduceability of duplexsonography for the measurement of portal venous flow is approved (Gastroenterology 1988,26:76), it was the aim of our study to elucidate whether duplexsonography alone allows to differentiate between portal hypertension and normal findings. Methods: 105 patients underwent portal venous duplexsonography (Toshiba-SAL-50A/SDL-01 A) under standardized conditions including day time, overnight fasting period, body position and respiratory phase. Fifty persons served as controls, 55 patients had confirmed portal hypertension due to liver cirrhosis (Child's A-C), oesophageal varices grade II-III and splenomegaly. Results: Portal venous flow in cirrhotics/controls amounted to 11.9 + 2.7 /15.2 + 2.6 cm/sec (p<0.001). The individual values ranged from 6.7 to 17.6 and 11.3 to 21.8 cm/sec, respectively. The reproduceability of the individual measurements did not exceed + 0.6 cm/sec. Success rate of measurement amounted to 75 and 95 %, respectively. Discussion: Though cirrhotics present with a significant lower portal venous flow than controls the large overlap between normal and pathological values demonstrates that duplexsonography is not reliable to diagnose portal hypertension. The value of the method for classification of portal hypertension and for physiological or pharmacological studies is not limited by our data.

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