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

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.

Role of echo Doppler ultrasonography in the evaluation of postprandial hyperemia in cirrhotic patients

“…Therefore, it is important to identify patients who experience increased postprandial hyperemic response, and treat these patients appropriately. EchoDoppler ultrasonography is a non-invasive test which is widely used to determine portal blood flow [4,7,8,10] In an observer-blinded study, it was shown that echo- Figure 1 Positive correlation between the portal blood velocity (PBV) and hepatic venous pressure gradient (HVPG ) (r = 0.8, P < 0.05). Figure 2 Inverse correlation between the superior mesenteric artery pulsatility index (SMA-PI) and hepatic venous pressure gradient ( HVPG) (r = -1, P < 0.01).…”

“…These measurements were obtained from the longitudinal section of the vessel by positioning the sample volume cursor over the vessel at a known angle of insonation, defined as an angle between the Doppler beam and the long axis of the vessel. The Doppler sample volume probe was positioned over the middle of the vessel and was manipulated to cover about 90% of the vessel section in order to detect the maximum Doppler frequency shift, related to the maximum velocity (4).…”

“…Doppler USG is highly sensitive in detecting postprandial hemodynamic changes [4] . Since hepatic venous pressure gradient measurement is the gold standard for the evaluation of portal hemodynamic changes, the aim of the present study was to compare the results obtained with this technique with echo-Doppler ultrasonography.…”

“…Sabba et al studied the sensitivity of echo-Doppler USG in detecting hemodynamic changes caused by postprandial hyperemia in an observer-blinded study. They found that echo-Doppler USG was highly sensitive for the evaluation of postprandial hyperemia [4] . Additionally, several studies have been done to investigate the effects of different drugs on postprandial hyperemia by using echo-Doppler USG [5][6][7][8] .…”

Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: Relationship between quantitative doppler measurements and the severity of portal hypertension and hepatic failure

“…[1][2][3] More recently, other parameters have been suggested for the study of the hepatic and superior mesenteric arteries, in which blood flow may be altered by liver diseases affecting mesenteric and hepatic arterial resistances. [4][5][6] It has been shown that portal as well as hepatic and splanchnic arterial Doppler parameters are significantly different in patients with liver disease and healthy subjects. However, few data are available regarding the relationship between these parameters and the severity of portal hypertension or the impairment of liver function in patients with cirrhosis.…”