Influence of esophageal varices and spontaneous portal-systemic shunts on postprandial splanchnic hemodynamics

Abstract

OBJECTIVE: The aim of the study was to assess postprandial splanchnic hemodynamic changes in cirrhosis in relation to variceal status. METHODS: In 9 healthy controls and 56 patients with liver cirrhosis, stratified according to variceal status and presence of spontaneous portal-systemic shunts, the portal vein diameter and flow velocity, the congestion index of the portal vein, and the resistive index of the superior mesenteric artery (SMA-RI) were studied by Doppler ultrasound before and 30, 60, and 120 min after the intake of a standard meal. Comparison of postprandial parameters with basal ones was done within each group by paired t test and among groups by ANOVA and Duncan test. RESULTS: Healthy controls and cirrhotic patients without varices showed similar significant splanchnic hemodynamic changes, namely a reduction of SMA-RI (−13% at 30 min) and a consequent increase in portal vein diameter (respectively, + 32% and + 17% in the two groups) and velocity (+66% and + 51%). A significant reduction of SMA-RI was also found in patients with varices, irrespective of the variceal size (range, −7 to −11%), but the expected portal vein dilation and velocity increase were progressively blunted with the increase of variceal size (range, 0–5% for diameter and 5–19% for velocity). Patients with spontaneous portal-systemic shunts showed a response similar to that of patients with large varices. Significant modification of the congestion index of the portal vein did not occur in any group. CONCLUSIONS: Our results show that the hemodynamic response to meal in patients with liver cirrhosis is influenced by the presence and size of esophageal varices and the presence of spontaneous portal-systemic shunts.