Document Detail

Increasing intra-abdominal pressure increases pressure, volume, and wall tension in esophageal varices.
MedLine Citation:
PMID:  12297841     Owner:  NLM     Status:  MEDLINE    
Many daily activities cause acute elevations of intra-abdominal pressure (IAP). In portal hypertensive cirrhotic patients, increased IAP increases absolute portal pressure and azygos blood flow, suggesting that it may have detrimental consequences at the esophageal varices. The aim of this study was to investigate the effects of increased IAP on variceal pressure, size, and wall tension. Endosonography and a noninvasive endoscopic pressure gauge were used to measure variceal pressure, radius, wall tension, and volume in baseline conditions and after increasing IAP by 10 mm Hg using an inflatable girdle in 14 patients with cirrhosis and esophageal varices. Increasing IAP markedly increased variceal pressure (from 13.3 +/- 4.2 to 17.4 +/- 4.6 mm Hg; P =.0001) and radius (from 2.9 +/- 1.0 to 3.9 +/- 1.1 mm; P =.0001). Consequently, wall tension dramatically increased (from 38.7 +/- 13.6 to 65.9 +/- 23.8 mm Hg. mm, +78%; P =.0001). Variceal volume increased significantly from 1,264 +/- 759 to 2,025 +/- 1,129 mm(3) (P =.0001). In conclusion, in portal hypertensive cirrhotic patients, increases in IAP have deleterious effects on variceal hemodynamics, markedly increasing the volume, pressure, and wall tension of the varices. Increases in IAP may contribute to the progressive dilatation that precedes the rupture of the varices in portal hypertension.
Angels Escorsell; Angels Ginès; Josep Llach; Joan C García-Pagán; Josep M Bordas; Jaume Bosch; Joan Rodés
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  36     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-09-25     Completed Date:  2002-10-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  936-40     Citation Subset:  IM    
Hepatic Hemodynamics Laboratory, Liver Unit, IMD, Hospital Clínic, Barcelona, Spain.
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MeSH Terms
Blood Pressure
Esophageal and Gastric Varices / physiopathology*
Heart Rate
Hypertension, Portal / physiopathology*
Liver Cirrhosis / physiopathology*
Middle Aged
Regional Blood Flow / physiology

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