S. Mezawa et al., Effect of transjugular intrahepatic portosystemic shunt formation on portal hypertensive gastropathy and gastric circulation, AM J GASTRO, 96(4), 2001, pp. 1155-1159
OBJECTIVES: The aim of this study was to investigate the effect of a transj
ugular intrahepatic portosystemic shunt (TIPS) on portal hypertensive gastr
opathy (PHG) and gastric hemodynamics.
METHODS: A total of 16 patients with cirrhosis and portal hypertensive gast
ropathy were prospectively studied. Of these, 12 patients underwent TIPS fo
r esophageal varices and four for refractory ascites. Gastric mucosal blood
flow (GMBF) was assessed by laser Doppler flowmeter, and total blood flow
(TBF) in submucosa and mucosa by near-infrared endoscopy. Portal venous pre
ssure was obtained by a transducer during the TIPS procedure. The severity
of portal hypertensive gastropathy was classified as none, mild, or severe.
The examinations were performed before and 2 wk after the procedure.
RESULTS: TIPS significantly reduced portal venous pressure. PHG improved in
all four patients with severe PHG and in five of 12 patients with mild PHG
after treatment. Gastric mucosal blood flow increased from 49.0 to 55.6 ml
/min/100 g after TIPS. In contrast, TBF decreased from 0.35/s to 0.27/s aft
er treatment. Liver function tests showed no significant changes before and
after the procedure.
CONCLUSIONS: It is considered that TIPS may have a beneficial effect on PHG
at least for a short time. The mechanism by which PHG improves may be clos
ely related to the improvement of the injured gastric perfusion in cirrhoti
c patients with PHG. (Am J Gastroenterol 2001:96: 1155-1159. (C) 2001 by Am
. Coll. of Gastroenterology).