DUPLEX-DOPPLER ULTRASONOGRAPHY IN THE EVALUATION OF CIRRHOTIC-PATIENTS WITH PORTAL-HYPERTENSION AND IN THE ANALYSIS OF THEIR RESPONSE TO DRUGS

Sixteen patients (15 males, aged 48-70) affected by liver cirrhosis and oesophageal varices were subjected to duplex-Doppler ultrasonographic study (DDUS). Four patients (three with a portal thrombosis and one with a hepatofugal portal flow) were excluded from the subsequent pharmacological test. The twelve remaining patients took part in a double blind cross-over study that evaluated the variations of heart rate (HR), mean systemic arterial pressure (SAP), portal vein diameter (PVD), maximal and mean portal flow velocity (PFV) after the administration of either 40 mg of propranolol or placebo per os, on two consecutive days. Propranolol caused no significant variation in mean SAP and in PVD, whereas it reduced the HR from 67.7 +/- 8.0 to 58.4 +/- 7.0 beats/min (mean +/- s.d.; P<0.001); the maxPFV dropped from 18.2 +/- 5.4 to 14.0 +/- 3.7 cm/s (P<0.001) and the meanPFV dropped from 15.3 +/- 4.1 to 13.2 +/- 3.1 cm/s (P<0.005). No significant variation was observed with placebo. After propranolol administration eight patients exhibited a significant maxPFV decrease, whereas the other four patients exhibited only a drop in HR, suggesting either drug inefficacy, inappropriate dosage or inadequate duration of treatment. DDUS is the only non-invasive method for the examination of the portal vein system. When pharmacological treatment of portal hypertension is contemplated, DDUS is of great interest: not only does it identify the patients with portal thrombosis or hepatofugal flow (in which cases beta-blocker therapy seems potentially dangerous and porta- caval shunts are not always feasible), it can also evaluate the effects of the drugs proposed on portal haemodynamics.