Double-blind investigation of the effects of propranolol and placebo on the pressure of esophageal varices in patients with portal hypertension

Authors

  • Faust Feu,

    1. Hepatic Hemodynamics Laboratory and Endoscopy Section, Liver Unit, Hospital Clinic i Provincial, University of Barcelona, 08036 Barcelona, Spain
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  • Josep M. Bordas,

    1. Hepatic Hemodynamics Laboratory and Endoscopy Section, Liver Unit, Hospital Clinic i Provincial, University of Barcelona, 08036 Barcelona, Spain
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  • Joan C. Garcia-Pagán,

    1. Hepatic Hemodynamics Laboratory and Endoscopy Section, Liver Unit, Hospital Clinic i Provincial, University of Barcelona, 08036 Barcelona, Spain
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  • Dr. Jaime Bosch,

    Corresponding author
    1. Hepatic Hemodynamics Laboratory and Endoscopy Section, Liver Unit, Hospital Clinic i Provincial, University of Barcelona, 08036 Barcelona, Spain
    • Hepatic Hemodynamics Laboratory, Liver Unit, Hospital Clinic i Provincial, Villarroel 170, 08036 Barcelona, Spain
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  • Joan Rodés

    1. Hepatic Hemodynamics Laboratory and Endoscopy Section, Liver Unit, Hospital Clinic i Provincial, University of Barcelona, 08036 Barcelona, Spain
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Abstract

This study was aimed at investigating the effects of propranolol on esophageal variceal pressure in patients with portal hypertension.

Variceal pressure was measured at endoscopy using a miniature pressure-sensitive gauge in 20 patients with portal hypertension. Measurements were obtained under baseline conditions and 20 min after double-blind administration of propranolol (0.15 mg/kg; n = 10) or an identical amount of placebo (normal saline, 0.3 ml/kg; n = 10).

Under baseline conditions, variceal pressure was similar in propranolol and placebo groups (14.1 ± 5 mm Hg vs. 14.9 ± 6.6 mm Hg, respectively; not significant). Placebo had no significant effect on variceal pressure (baseline = 14.9 ± 6.6 mm Hg; placebo = 15.5 ± 6.6 mm Hg; not significant), and values after placebo administration were closely correlated with baseline values (r = 0.98; y = 1.1 + 0.97 x; p < 0.0001). In contrast, propranolol caused a significant decrease in the pressure of esophageal varices (from 14.1 ± 5 mm Hg to 11.3 ± 4.4 mm Hg; p < 0.002). No significant changes in the size of esophageal varices were observed after propranolol or placebo administration.

This study shows (a) the endoscopic pressure-gauge technique has a low variability and may be used to assess acute drug-induced changes in variceal pressure; and (b) propranolol causes significant decreases in variceal pressure in patients with portal hypertension and esophageal varices. (HEPATOLOGY 1991;13:917–922.)

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