Premium
Potential stagnation in the splanchnic hemodynamics demonstrated by the dynamic microbubbles in chronic liver disease
Author(s) -
Sekimoto Tadashi,
Maruyama Hitoshi,
Kondo Takayuki,
Shimada Taro,
Kiyono Soichiro,
Yokosuka Osamu
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12875
Subject(s) - medicine , postprandial , splanchnic circulation , cirrhosis , gastroenterology , splanchnic , hemodynamics , superior mesenteric vein , superior mesenteric artery , chronic liver disease , liver disease , cardiology , portal vein , insulin
Background and Aim Impaired splanchnic hemodynamics are well‐documented phenomena in cirrhosis. However, comprehensive hemodynamic features from the superior mesenteric artery ( SMA ) to the superior mesenteric vein ( SMV ) via intestinal capillaries have not been studied. The aim was to examine splanchnic hemodynamics and their relationship with clinical presentations. Methods Contrast‐enhanced ultrasound was performed for both the SMA and SMV under fasting conditions and postprandially following ingestion of a liquid diet. The microbubble traveling time ( MTT ) was determined as the difference between the contrast onset in the SMA and SMV , indicating the time required for microbubble transit through the splanchnic circulation. Results There were 192 subjects for fasting conditions (81 cirrhosis, 72 chronic hepatitis, 39 healthy controls), and 74/192 for postprandial conditions (44 cirrhosis, 11 chronic hepatitis, 19 healthy controls). The MTT (fasting; postprandial) was significantly longer in cirrhosis (7.7 ± 2.9 s; 7.0 ± 0.3 s) than in controls (5.4 ± 2.3 s, P < 0.001; 3.9 ± 0.9 s, P < 0.001) and chronic hepatitis (6.3 ± 2.5 s, P = 0.007; 5.1 ± 1.4 s, P = 0.013). The MTT ratio (postprandial/fasting) showed disease‐related changes: 0.75 ± 0.20 in controls, 0.78 ± 0.15 in chronic hepatitis, and 1.00 ± 0.28 in cirrhosis ( P = 0.003, vs controls; P = 0.036, vs chronic hepatitis). Conclusions The real‐time observation of traveling microbubble on the sonogram revealed a prolonged transit with a weak postprandial response in the intestinal circulation, suggesting better understanding of underlying pathophysiology of splanchnic hemodynamics in chronic liver disease.