Evaluation of postprandial hyperemia in superior mesenteric artery and portal vein in healthy and cirrhotic humans: An operator-blind echo-Doppler study

Authors

  • Carlo Sabbá,

    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
    2. Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06510
    Current affiliation:
    1. Istituto di Clinica Medica I, University of Bari, Bari 70100, Italy
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  • Giovanna Ferraioli,

    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
    2. Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06510
    Current affiliation:
    1. Divisione di Medicina, Ospedale Civile di Scafati, Scafati 84018, Italy
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  • Paul Genecin,

    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
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  • Luis Colombato,

    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
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  • Paolo Buonamico,

    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
    2. Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06510
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  • Emanuel Lerner,

    1. Research Service, Veterans Affairs Medical Center, West Haven, 06516
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  • Kenneth J. W. Taylor,

    1. Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06510
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  • Roberto J. Groszmann M.D.

    Corresponding author
    1. Hepatic Hemodynamic Lab, Veterans Affairs Medical Center, Yale University School of Medicine, West Haven 06516
    • VA Medical Center, 950 Campbell Avenue, West Haven, Connecticut 06516
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Abstract

In an operator-blind design, we used an echo-Doppler duplex system to examine superior mesenteric artery and portal vein hemodynamics on two consecutive mornings in 12 fasting cirrhotic patients and 12 matched controls, randomized to a standardized 355 kcal mixed-liquid meal vs. water. Cross-sectional area and mean velocity were recorded from the portal vein and superior mesenteric artery at 30 min intervals, from 0 min to 150 min after ingestion. Flows were calculated. Pulsatility index, an index related to vascular resistance, was obtained for the mesenteric artery. Baseline flows did not differ between cirrhotic patients and control patients, but pulsatility index was reduced in the cirrhotic subjects. Maximal postprandial hyperemia was attained at 30 min. Cirrhotic patients showed a blunted hyperemic response to food. In normal controls, portal vein area increased significantly after the meal from 30 min to 150 min, whereas in cirrhotic patients a significant difference occurred only at 30 min. Pulsatility index in both groups was significantly reduced after eating, and this reduction persisted up to 150 min. No changes after ingestion of water were observed. Echo-Doppler was very sensitive in detecting postprandial splanchnic hemodynamic changes and differences between cirrhotic patients and normal subjects. Mesenteric artery pulsatility index was more sensitive than flow in detecting baseline hemodynamic differences. In cirrhotic patients, portal postprandial hyperemia was mainly related to the increase in mean velocity. (HEPATOLOGY 1991;13:714–718.)

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