Relationship between gastric mucosal changes and hemodynamic patterns in alcoholic cirrhosis. A prospective study
Bretagne, J.F.; Guyader, D.; Darnault, P.; Raoul, J.L.; Siproudhis, L.; De Malézieu, N.; Gosselin, M.
Gastroenterologie Clinique et Biologique 17(10): 636-642
1993
ISSN/ISBN: 0399-8320 PMID: 8288075 Document Number: 417434
Most gastric mucosal changes in cirrhosis are thought to be related to vasculopathy. The aim of this study was to determine whether there was a relationship between gastric mucosal changes and hemodynamic in cirrhosis. Thirty patients with alcoholic cirrhosis were divided into four groups: no congestive gastropathy (n = 6), mild congestive gastropathy type 1 (discrete mosaic pattern) (n = 9), mild congestive gastropathy type 2 (obvious mosaic pattern) (n = 9), and severe congestive gastropathy (n = 6). The four groups did not significantly differ with respect to clinical and biochemical data, degree of hepatic dysfunction, or endoscopic signs of portal hypertension. A hyperdynamic circulatory syndrome was observed in most patients, but tended to be more pronounced in patients with severe congestive gastropathy and mild congestive gastropathy type 2 as compared to patients with normal mucosa, or mild congestive gastropathy type 1. Systemic vascular resistance was found to be significantly lower in high-grade patients (mild congestive gastropathy type 2 + severe congestive gastropathy, n = 15) as compared with low-grade patients (no congestive gastropathy + mild congestive gastropathy type 1, n = 15) (736 +- 267 vs 1 046 +- 403 dyne.s.cm-5, P = 0.02). Neither splanchnic hemodynamics as assessed by the degree of portal hypertension (hepatic venous pressure gradient) and superior mesenteric artery vascular resistance (Doppler measurement of the pulsatility index) catecholamines or glucagon serum levels differed significantly between the four groups. In conclusion, the severity of gastric mucosal changes in alcoholic cirrhosis tend to be related to the magnitude of hyperkinetic circulation, but not to the degree of portal hypertension nor to the severity of liver disease.