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Duplex‐Doppler evaluation of the effects of propranolol and isosorbide‐5‐mononitrate on portal flow and splanchnic arterial circulation in cirrhosis
Author(s) -
Fabio Piscaglia,
Stefano Gaiani,
S. Siringo,
Laura Gramantieri,
Carla Serra,
Luigi Bolondi
Publication year - 1998
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1998.00333.x
Subject(s) - medicine , isosorbide mononitrate , propranolol , splanchnic circulation , splanchnic , cirrhosis , isosorbide dinitrate , anesthesia , cardiology , hemodynamics , superior mesenteric artery , placebo , alternative medicine , pathology
Background: A decrease in portal flow is an important pharmacological effect of drugs used for the prophylaxis of variceal bleeding. Aim: To assess the acute and chronic effects of propranolol, and the effect of the acute addition of isosorbide‐5‐mononitrate, on splanchnic circulation. Methods: Measurements of portal blood flow volume (PBFV) and of Doppler ultrasound pulsatility index of the superior mesenteric, femoral and interlobar renal arteries were performed in 10 cirrhotic patients with varices at baseline, 90 min after propranolol or placebo, after 30 days of chronic propranolol treatment and 45 min after the addition of isosorbide‐5‐mononitrate. Results: The mean PBFV was significantly lower at all times than at baseline, with the greatest mean percentage decrease achieved after the addition of isosorbide‐5‐mononitrate (≥ 20% in all patients). Acute changes, however, did not predict the chronic effects in many patients. Isosorbide‐5‐mononitrate significantly increased the mesenteric and femoral pulsatility indices, whereas no significant change was observed in the kidney. Conclusions: Propranolol significantly decreases PBFV, but chronic effects cannot be reliably predicted by the acute change. All patients achieved a decrease in PBFV of ≥ 20% after the acute addition of isosorbide‐5‐mononitrate to chronic propranolol treatment.