Etiology of portal hypertension may influence gastrointestinal transit

Background: Gastrointestinal transit studies have shown contradictory results in patients with portal hypertension. We have studied gastric emptying, small-bowel transit and colonic transit in patients with portal hypertension. The association between small-bowel bacterial overgrowth and gastrointestinal transit was assessed. Methods: Sixteen patients ( 6 females) with portal hypertension and esophageal varices were included. A newly developed radiological procedure was used to measure gastrointestinal transit during one visit. Variceal pressure was measured and culture of small-bowel aspirate was used to diagnose small-bowel bacterial overgrowth. The results were compared to results obtained in 83 healthy subjects. Results: Half gastric emptying time in male patients was 3.8 (0.9 - 5.8) h versus 2.5 (0.4 - 4.0) h in healthy males (median and percentile 10 - 90; P < 0.05). Small-bowel residence time in male patients was 5.9 (2.0 - 13.7) h versus 3.2 (1.5 - 6.0) h in healthy males (P < 0.05). Small-bowel residence time in patients with bacterial overgrowth was significantly longer than in patients without bacterial overgrowth. Small-bowel residence time was also significantly longer in male patients with alcoholic cirrhosis as compared to male patients with other causes of portal hypertension. Colonic transit in all patients and gastric emptying and small-bowel transit in female patients were not significantly different from healthy subjects. Conclusion: Etiology of liver disease and gender may influence transit in patients with portal hypertension. Small-bowel bacterial overgrowth was associated with delayed small-bowel transit.