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Pharmacological Agents and Portal Hypertension

  • Miquel Navasa
  • Jaime Bosch
  • Joan Rodés

Abstract

The pharmacological treatment of portal hypertension includes both the treatment of the acute bleeding episode and prevention of variceal bleeding [1]. The latter may be subdivided in two different clinical situations: prevention of variceal rebleeding in patients who have already bled from their varices and prophylaxis of the first hemorrhage.

Keywords

Portal Hypertension Esophageal Varix Hepatic Blood Flow Portal Pressure Lower Esophageal Sphincter Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bosch J, Navasa M, García-Pagán JC, DeLacy AM, Rodés J (1989) Portal hypertension. Med Clin N Am 73: 931–953PubMedGoogle Scholar
  2. 2.
    Bosch J (1984) ¿Por qué sangran las varices esofágicas?. Med Clin (Barc) 82: 401–403Google Scholar
  3. 3.
    Polio J, Groszmann RJ (1986) Hemodynamic factors involved in the development and rupture of esophageal varices: A pathophysiologic approach to treatment. Semin Liver Dis 6: 318–331PubMedCrossRefGoogle Scholar
  4. 4.
    Bosch J, Groszmann RJ (1984) Measurement of the azygos venous blood flow by a continuous thermodilution technique. An index of blood flow through gastroesophageal collaterals in cirrhosis. Hepatology 4: 424–429PubMedCrossRefGoogle Scholar
  5. 5.
    Bosch J (1985) Effect of pharmacological agents on portal hypertension: A haemodynamic appraisal. Clin Gastroenterol 1: 169–184Google Scholar
  6. 6.
    Bosch J, Mastai R, Kravetz D, Navasa M, Rodés J (1986) Hemodynamic evaluation of the patient with portal hypertension. Semin Liver Dis 4: 309–317CrossRefGoogle Scholar
  7. 7.
    Lebrec D (1987) Drugs for portal hypertension. J Gastroenterol Hepatol 2: 361–374CrossRefGoogle Scholar
  8. 8.
    Barbare JC, Poupon R, Jaillon P, Bories P, Aussanaire M, Darnis F, Michel H, Cheymol G (1984) The influence of vasoactive agents on metabolic activity of the liver in cirrhosis: A study of the effects of posterior pituitary extract, vasopressin, and somatostatin. Hepatology 4: 59–62PubMedCrossRefGoogle Scholar
  9. 9.
    Bosch J, Kravetz D, Rodés J (1981) Effects of somatostatin on hepatic and systemic hemodynamics in patients with cirrhosis of the liver. Comparison with vasopressin. Gastroenterology 80: 518–525PubMedGoogle Scholar
  10. 10.
    Groszmann RJ, Kravetz D, Bosch J, Glickmann M, Bruix J, Bredfeldt J, Conn HO, Rodés J, Storer EH (1982) Nitroglycerin improves the hemodynamic response to vasopressin in portal hypertension. Hepatology 2: 757–762PubMedCrossRefGoogle Scholar
  11. 11.
    Bosch J, Kravetz D, Navasa M (1987) Effects of vasopressin on variceal pressure and azygos blood flow. In: Lebrec D, Blei AT (eds) Vasopressin analogs and portal hypertension. John Libbey Eurotext, Paris, pp 95–104Google Scholar
  12. 12.
    Bosch J, Bordas JM, Mastai R, Kravetz D, Navasa M, Chesta J, Pizcueta MP, Carcía-Pagán JC, Rodés J (1988) Effects of vasopressin on the intravariceal pressure in patients with cirrhosis: Comparison with the effects on portal pressure. Hepatology 8: 861–865PubMedCrossRefGoogle Scholar
  13. 13.
    Poupon R, Islam S, Chretien Y, Ballet F (1987) Effects of vasopressin on hepatic metabolic activity in cirrhosis. In: Lebrec D, Blei AT (eds) Vasopressin analogs and portal hypertension. John Libbey Eurotext, Paris, pp 75–82Google Scholar
  14. 14.
    Bichet D, Schrier RW (1987) Endogenous vasopressin in liver disease. In: Lebrec D, Blei AT (eds) Vasopressin analogs and portal hypertension. John Libbey Eurotext, Paris, pp 37–47Google Scholar
  15. 15.
    Zito RA, Diez AR, Groszmann RJ (1983) Comparative effect of nitroglycerin and nitroprusside on vasopressin-induced cardiac dysfunction in the dog. J Cardiovasc Pharmacol 5: 586–591PubMedCrossRefGoogle Scholar
  16. 16.
    Bosch J, Grosmann RJ, García-Pagán JC, Terés J, García-Tsao G, Navasa M, Mas A, Rodés J (1989) Association of transdermal nitroglycerin to vasopressin infusion in the treatment of variceal hemorrhage: A placebo-controlled clinical trial. Hepatology 10: 962–968PubMedCrossRefGoogle Scholar
  17. 17.
    Kravetz D, Bosch J, Terés J, Bruix J, Rimola A, Rodés J (1984) Comparison of intravenous somatostatin and vasopressin infusions in treatment of acute variceal hemorrhage. Hepatology 4: 442–446PubMedCrossRefGoogle Scholar
  18. 18.
    Barr JW, Robert CL, Rösch J (1975) Similarity of arterial and intravenous vasopressin on portal and systemic hemodynamics. Gastroenterology 69: 13–19PubMedGoogle Scholar
  19. 19.
    Millet B, Huet PM, Lavoie P, Viallet A (1975) Portal and systemic effects of selective infusion of vasopressin into the superior mesenteric artery in cirrhotic patients. Gastroenterology 69: 6–12Google Scholar
  20. 20.
    Huet PM, Valla D, Lafortune M, Marleau D (1987) Hemodynamic effects of vasopressin in cirrhotic patients. In: Lebrec D, Blei AT (eds) Vasopressin analogs and portal hypertension. John Libbey Eurotext, Paris, pp 83–94Google Scholar
  21. 21.
    Groszmann RJ (1987) Vasopressin and nitroglycerin In: Lebrec D, Blei AT (eds) Vasopressin analogues and portal hypertension. John Libbey Eurotext, Paris, pp 113–123Google Scholar
  22. 22.
    Westaby D, Gimson A, Hayes PC, Williams R (1988) Haemodynamic response to intravenous vasopressin and nitroglycerin in portal hypertension. Gut 29: 372–377PubMedCrossRefGoogle Scholar
  23. 23.
    Kravetz D, Cummings SA, Groszmann RJ (1987) Hyposensitivity to vasopressin in a hemorrhaged-transfused rat model of portal hypertension. Gastroenterology 93: 170–175PubMedGoogle Scholar
  24. 24.
    Valla D, Geoffroy P, Girod C, Lebrec D (1986) Circulatory actions of vasopressin in anaesthetized rats with portal hypertension subjected to haemorrhage. J Hepatol 2: 328–339PubMedCrossRefGoogle Scholar
  25. 25.
    Valla D, Girod C, Lee SS, Braillon A, Lebrec D (1988) Lack of vasopressin action on splanchnic hemodynamics during bleeding: A study in conscious, portal hypertensive rats. Hepatology 8: 10–15PubMedCrossRefGoogle Scholar
  26. 26.
    Blei AT, Groszmann RJ, Gusberg R, Conn HO (1980) Comparison of vasopressin and triglycyllysine vasopressin on splanchnic and systemic hemodynamics in dogs. Dig Dis Sci 25: 688–694PubMedCrossRefGoogle Scholar
  27. 27.
    Merkerl C, Gatta A, Bolognesi M, Finucci G, Battaglia G, Angeli P, Zuin R (1988) Hemodynamic changes of systemic, hepatic, and splenic circulation following triglycyl-lysin-vasopressin administration in alcoholic cirrhosis. Dig Dis Sci 33: 1103–1109CrossRefGoogle Scholar
  28. 28.
    Valla D, Lee SS, Moreau R, Hadengue A, Sayegh R, Lebrec D (1985) Efects de la glypressine sur les circulations splanchnique et systémique des malades atteints de cirrhose. Gastroenterol Clin Biol 9: 877–880PubMedGoogle Scholar
  29. 29.
    Tyden G, Samnegard H, Thulin L, Friman L, Efendic S (1978) Treatment of bleeding esophageal varices with somatostatin. (correspondence) N Engl J Med 299: 1466–1467PubMedCrossRefGoogle Scholar
  30. 30.
    Bosch J, Kravetz D, Mastai R, Navasa M, Silva G, Chesta J, Rodés J (1988) Effects of somatostatin in patients with portal hypertension. Horm Res 29: 99–102PubMedCrossRefGoogle Scholar
  31. 31.
    Eriksson LS, Law DH, Sato Y, Wahren J (1984) Influences of somatostatin on splanchnic haemodynamics in patients with liver cirrhosis. Clin Physiol 4: 5–11PubMedCrossRefGoogle Scholar
  32. 32.
    Kravetz D, Bosch J, Arderiu MT, Pizcueta MP, Casamitjana R, Rivera F, Rodés J (1988) Effects of somatostatin on splanchnic hemodynamics and plasma glucagon in portal hypertensive rats. Am J Physiol 254: G322–G328PubMedGoogle Scholar
  33. 33.
    Clements D, Rhodes JM, Elias E (1986) Effect of somatostatin on oesophageal variceal pressure assessed by direct measurement. J Hepatol 2: 262–266PubMedCrossRefGoogle Scholar
  34. 34.
    Jenkins SA, Baxter JN, Corbett WA, Shields R (1985) Effects of a somatostatin analogue SMS 201–995 on hepatic haemodynamics in the pig and on intravariceal pressure in man. Br J Surg 72: 1009–1012PubMedCrossRefGoogle Scholar
  35. 35.
    Kleber G, Sauerbruch T, Fischer G, Paumgartner G (1988) Somatostatin does not reduce oesophageal variceal pressure in liver cirrhosis. Gut 29: 153–156PubMedCrossRefGoogle Scholar
  36. 36.
    Eriksson LS, Brundin T, Söderlund C, Wahren J (1987) Haemodynamic effects of a long-acting somatostatin analogue in patients with liver cirrhosis. Scand J Gastroenterol 22: 919–925PubMedCrossRefGoogle Scholar
  37. 37.
    Cerini R, Lee SS, Hadengue A, Koshy A, Girod C, Lebrec D (1988) Circulatory effects of somatostatin analogue in two conscious rat models of portal hypertension. Gastroenterology 94: 703–708PubMedGoogle Scholar
  38. 38.
    Navasa M, Bosch J, Chesta J, Bru C, Pizcueta P, García-Pagán JC, Betz C, Casamitjana R, Rodés J (1988) Haemodynamic effects of subcutaneous administration of SMS 201–995, a long acting somatostatin analog, in patients with cirrhosis and portal hypertension (abstract). J Hepatol 7: s64Google Scholar
  39. 39.
    Burroughs AK, Jenkins WJ, Sherlock S, Dunk A, Walt RP, Osuafor TOK, Mackie S, Dick R (1983) Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. N Engl J Med 309: 1539–1542PubMedCrossRefGoogle Scholar
  40. 40.
    Calès P, Pascal JP, and a multicenter study group (1987) Propranolol in the prevention of the first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 317: 856–861PubMedCrossRefGoogle Scholar
  41. 41.
    Colombo M, De Franchis R, Tommasini M, Sangiovanni A, Dioguardi N (1989) β-Blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial. Hepatology 9: 433–438PubMedCrossRefGoogle Scholar
  42. 42.
    Lebrec D, Poynard T, Bernuau J, Bercoff E, Nouel O, Capron JP, Poupon R, Bouvry M, Rueff B, Benhamou JP (1984) A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: A final report. Hepatology 4: 355–358PubMedCrossRefGoogle Scholar
  43. 43.
    Villeneuve JP, Pomier-Layrargues G, Infante-Rivard C, Willems B, Huet PM, Marleau D, Viallet A (1986) Propranolol for the prevention of recurrent variceal hemorrhage: A controlled trial. Hepatology 6: 1239–1243PubMedCrossRefGoogle Scholar
  44. 44.
    Abshagen U, Betzien G, Endele R, Kaufmann B (1981) Pharmacokinetics of intravenous and oral isosorbide 5 mononitrade. Eur J Pharmacol 20: 269–275CrossRefGoogle Scholar
  45. 45.
    Bhathal PS, Grossmann HJ (1985) Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators. J Hepatol 1: 325–337PubMedCrossRefGoogle Scholar
  46. 46.
    Lebrec D, Hillon P, Muñoz C, Goldfarb G, Nouel O, Benhamou JP (1982) The effect of propranolol on portal hypertension in patients with cirrhosis: A hemodynamic study. Hepatology 2: 523–527PubMedCrossRefGoogle Scholar
  47. 47.
    Bosch J, Mastai R, Kravetz D, Bruix J, Gaya J, Rigau J, Rodés J (1984) Effects of propranolol on azygos venous blood flow and hepatic and systemic hemodynamics in cirrhosis. Hepatology 4: 1200–1205PubMedCrossRefGoogle Scholar
  48. 48.
    Calès P, Braillon A, Girod C, Lebrec D (1985) Acute effects of propranolol on splanchnic circulation in normal and portal hypertensive rats. J Hepatol 1: 349–357PubMedCrossRefGoogle Scholar
  49. 49.
    Garcia-Tsao G, Grace ND, Groszmann RJ, Conn HO, Bermann MM, Patrick MJC, Morse SS, Alberts JL (1986) Short-term effects of propranolol on portal venous pressure. Hepatology 6: 101–106PubMedCrossRefGoogle Scholar
  50. 50.
    García-Pagán JC, Navasa M, Ruiz del Arbol L, Gaya J, Pizcueta P, Feu F, Rivera F, Bosch J, Rodés J (1989) Lymphocyte Beta-2 adrenoceptors, plasma catecholamines and haemodynamic response to propranolol in patients with cirrhosis and portal hypertension. J Hepatol S1: S34CrossRefGoogle Scholar
  51. 51.
    Kroeger RJ, Groszmann RJ (1985) Increased portal venous resistance hinders portal pressure reduction during the administration of β-adrenergic blocking agents in a portal hypertension model. Hepatology 5: 97–101PubMedCrossRefGoogle Scholar
  52. 52.
    Valla D, Gaudin C, Geoffroy P, Braillon A, Lee SS, Lebrec D (1987) Reversal of adrenaline-induced increase in azygos blood flow in patients with cirrhosis receiving propranolol. J Hepatol 4: 86–92PubMedCrossRefGoogle Scholar
  53. 53.
    Mastai R, Bosch J, Navasa M, Kravetz D, Bruix J, Viola C, Rodés J (1987) Effects of alpha-adrenergic stimulation and beta-adrenergic blockade on azygos blood flowand splanchnic haemodynamics in patients with cirrhosis. J Hepatol 4: 71–79PubMedCrossRefGoogle Scholar
  54. 54.
    Koshy A, Girod C, Lee SS, Hadengue A, Cerini R, Lebrec D (1989) Discrepancy between portal pressure and systemic hemodynamic changes after incremental doses of propranolol in awake portal hypertensive rats. Hepatology 9: 269–273PubMedCrossRefGoogle Scholar
  55. 55.
    Vorobioff J, Picabea E, Villavicencio R, Puccini V, Rossi O, Bordato J, Audano M (1987) Acute and chronic hemodynamic effects of propranolol in unselected cirrhotic patiens. Hepatology 7: 648–653PubMedCrossRefGoogle Scholar
  56. 56.
    Groszmann RJ, Bosch J, Grace N, Conn HO, García-Tsao G, Navasa M, Albert J, Bermann M, Patrick M, Rodés J (1988) Hemodynamic events in a prospective randomized trial of propranolol vs placebo in the prevention of the first variceal hemorrhage. Hepatology 5: 1242Google Scholar
  57. 57.
    Mastai R, Bosch J, Bruix J, Navasa N, Kravetz D, Rodés J (1989) β-Blockade with propranolol and hepatic artery blood flow in patients with cirrhosis. Hepatology 10: 269–272PubMedCrossRefGoogle Scholar
  58. 58.
    Vinel JP, Caucanas JP, Cales P, Suduca JM, Voigt JJ, Pascal JP (1988) Effect of propranolol on metabolic activity of the liver in patients with alcoholic cirrhosis. J Hepatol 7: 186–192PubMedCrossRefGoogle Scholar
  59. 59.
    Lebrec D (1989) Propranolol and portal hypertension. In: Bosch J, Rodés J (eds) Recent advances in the pathophysiology and therapy of portal hypertension. Ares-Serono Symposia, Rome, pp 219–235Google Scholar
  60. 60.
    Merkel C, Sacerdoti D, Finucci GF, Zuin R, Bazzerla G, Bolognesi M, Gatta A (1986) Effect of nadolol on liver haemodynamics and function in patients with cirrhosis. Br J Clin Pharmacol 21: 713–719PubMedCrossRefGoogle Scholar
  61. 61.
    Hillon P, Lebrec D, Muñoz C, Jungers M, Goldfarb G, Benhamou JP (1982) Comparison of the effects of a cardioselective and a nonselective β-blocker on portal hypertension in patients with cirrhosis. Hepatology 2: 528–531PubMedCrossRefGoogle Scholar
  62. 62.
    Mills PR, Rae AP, Farah DA, Russell RI, Lorimer AR, Carter DC (1984) Comparison of three adrenoreceptor blocking agents in patients with cirrhosis and portal hypertension. Gut 25: 73–78PubMedCrossRefGoogle Scholar
  63. 63.
    Ideo G, Bellati G, Fesce E, Grimoldi D (1988) Nadolol can prevent the first gastrointestinal bleeding in cirrhotics: A prospective, randomized study. Hepatology 8: 6–9PubMedCrossRefGoogle Scholar
  64. 64.
    Blei AT (1989) Vasodilator therapy of portal hypertension: Focus on the liver. Hepatology 9: 896–899PubMedCrossRefGoogle Scholar
  65. 65.
    Reichen J, Le M (1986) Verapamil favorably influences hepatic microvascular exchange and function in rats with cirrhosis of the liver. J Clin Invest 78: 448–455PubMedCrossRefGoogle Scholar
  66. 66.
    Blei At, García-Tsao G, Groszmann RJ, Kahrilas P, Ganger D, Morse S, Fung HL (1987) Hemodynamic evaluation of isosorbide dinitrate in alcoholic cirrhosis. Pharmacokinetic-hemodynamic interactions. Gastroenterology 93: 576–583PubMedGoogle Scholar
  67. 67.
    Blei AT, Gottstein J (1986) Isosorbide dinitrate in experimental portal hypertension: a study of factors that modulate the hemodynamic response. Hepatology 6: 107–111PubMedCrossRefGoogle Scholar
  68. 68.
    Garcia-Tsao G, Groszmann RJ (1987) Portal hemodynamics during nitroglycerin administration in cirrhotic patients. Hepatology 7: 805–809PubMedCrossRefGoogle Scholar
  69. 69.
    Navasa M, Bosch J, Chesta J, Rodés J (1989) Isosorbide-5-mononitrate reduces hepatic vascular resistance and portal pressure in patients with cirrhosis. Gastroenterology 96: 1110–1118PubMedGoogle Scholar
  70. 70.
    Freeman G, Barton JR, Record CO (1985) Effect of isosorbide dinitrate, verapamil and labetalol in portal pressure in cirrhosis. Br Med J 291: 561–562CrossRefGoogle Scholar
  71. 71.
    Merkel C, Finucci G, Zuin R, Bazzerla G, Bolognesi M, Sacerdoti D, Gatta A (1987) Effects of isosorbide dinitrate in alcoholic cirrhosis. J Hepatol 4: 174–180PubMedCrossRefGoogle Scholar
  72. 72.
    Dawson J, Gertsch P, Mosimann F, West R, Elias E (1985) Endoscopic variceal pressure measurements: response to isosorbide dinitrate. Gut 26: 843–847PubMedCrossRefGoogle Scholar
  73. 73.
    Henriksen JH, Ring-Larsen H, Christensen NJ (1984) Sympathetic nervous activity in cirrhosis. A survey of plasma catecholamine studies. J Hepatol 1: 55–65CrossRefGoogle Scholar
  74. 74.
    Mols P, Hallemans R, Melot C, Lejeune P, Naeije R (1989) Systemic and regional hemodynamic effects of isosorbide dinitrate in patients with liver cirrhosis and portal hypertension. J Hepatol 1989 8: 316–324PubMedCrossRefGoogle Scholar
  75. 75.
    García-Pagán JC, Feu F, Navasa M, Bru C, Ruiz del Arbol L, Bosch J, Rodés J (1990) Long-term hemodynamic effects of isosorbide-5-mononitrate in patients with cirrhosis and portal hypertension. J Hepatol 11: 189–195PubMedCrossRefGoogle Scholar
  76. 76.
    Vinel JP, Monnin JL, Combis JM, Calés P, Desmorat H, Pascal JP (1990) Hemodynamic evaluation of molsidomine: A vasodilator with antianginal properties in patients with alcoholic cirrhosis. Hepatology 11: 239–242PubMedCrossRefGoogle Scholar
  77. 77.
    Vinel JP, Caucanas JP, Combis JM, Claes P, Voigt JJ, Pascal JP (1989) Verapamil has no effect on porto-hepatic pressure gradient, hepatic blood flow and elimination function of the liver in patients with cirrhosis. J Hepatol 8: 302–307PubMedCrossRefGoogle Scholar
  78. 78.
    Navasa M, Bosch J, Reichen J, Bru C, Mastai R, Zysset T, Silva G, Rodés J (1988) Effects of verapamil on hepatic and systemic hemodynamics in patients with cirrhosis and portal hypertension. Hepatology 8: 850–854PubMedCrossRefGoogle Scholar
  79. 79.
    Marteau P, Ballet F, Chazouillères, Chrétien Y, Rey C, Petit D, Poupon R (1989) Effect of vasodilators on hepatic microcirculation in cirrhosis: A study in the isolated perfused rat liver. Hepatology 9: 820–823PubMedCrossRefGoogle Scholar
  80. 80.
    Koshy A, Hadengue A, Lee SS, Jirón MI, Lebrec D (1987) Possible deleterious hemodynamic effect of nifedipine on portal hypertension in patients with cirrhosis. Clin Pharmacol Ther 42: 295–298PubMedCrossRefGoogle Scholar
  81. 81.
    Cummings SA, Groszmann RJ, Kaumann AJ (1986) Hypersensitivity of mesenteric veins to 5-hydroxytryptamine and ketanserin-induced reduction of portal pressure in portal hypertensive rats. Br J Pharmacol 89: 501–513PubMedCrossRefGoogle Scholar
  82. 82.
    Kaumann AJ, Morgan JS, Groszmann RJ (1988) ICI169, 369 selectively blocks 5-hydroxytryptamine-2 receptors and lowers portal pressure in portal hypertensive rats. Gastroenterology 95: 1601–1606PubMedGoogle Scholar
  83. 83.
    Hadengue A, Lee SS, Moreau R, Braillon A, Lebrec D (1987) Beneficial hemodynamic effects of ketanserin in patients with cirrhosis: Possible role of serotoninergic mechanisms in portal hypertension. Hepatology 7: 644–647PubMedCrossRefGoogle Scholar
  84. 84.
    Vorobioff J, Garcia-Tsao G, Groszmann RJ, Aceves G, Picabea E, Villavicencio R, Hernandez-Ortiz J (1989) Long-term hemodynamic effects of ketanserin, a 5-hydroxytryptamine blocker, in portal hypertensive patients. Hepatology 9: 88–91PubMedCrossRefGoogle Scholar
  85. 85.
    Cummings SA, Kaumann AJ, Groszmann RJ (1988) Comparison of the hemodynamic responses to ketanserin and prazosin in portal hypertensive rats. Hepatology 8: 1112–1115PubMedCrossRefGoogle Scholar
  86. 86.
    Mastai R, Rocheleau B, Huet PM (1989) Serotonin blockade in conscious, unrestrained cirrhotic dogs with portal hypertension. Hepatology 9: 265–268PubMedCrossRefGoogle Scholar
  87. 87.
    Pariente A, Bataille C, Bercoff E, Lebrec D (1985) Acute effects of captopril on systemic and renal hemodynamics and on renal function in cirrhotic patients with ascites. Gastroenterology 88: 1255–1259PubMedGoogle Scholar
  88. 88.
    Eriksson LS, Kagedal B, Wahren J (1984) Effects of captopril on hepatic venous pressure and blood flow in man. Am J Med 76: 66–70PubMedCrossRefGoogle Scholar
  89. 89.
    Moreau R, Lee SS, Hadengue A, Braillon A, Lebrec D (1987) Hemodynamic effects of a clonidine-induced decrease in sympathetic tone in patients with cirrhosis. Hepatology 7: 149–154PubMedCrossRefGoogle Scholar
  90. 90.
    Willet IR, Jennings G, Esther M, Dudley FJ (1896) Sympathetic tone modulates portal venous pressure in cirrhosis. Lancet II: 939–942Google Scholar
  91. 91.
    Kroeger RJ, Groszmann RJ (1985) The effect of the combination of nitroglycerin and propranolol on splanchnic and systemic hemodynamics in a portal hypertensive rat model. Hepatology 5: 425–430PubMedCrossRefGoogle Scholar
  92. 92.
    García-Pagán JC, Navasa M, Bosch J, Bru C, Pizcueta P, Rodés J (1990) Enhancement of portal pressure reduction by the association of isosorbide-5-mononitrate to propranolol administration in patients with cirrhosis. Hepatology 11: 230–238PubMedCrossRefGoogle Scholar
  93. 93.
    Hadengue A, Moreau R, Cerini R, Koshy A, Lee S, Lebrec D (1989) Combination of ketanserin and verapamil or propranolol in patients with alcoholic cirrosis: Search for an additive effect. Hepatology 9: 83–87PubMedCrossRefGoogle Scholar
  94. 94.
    Miskowik J (1978) How the lower oesophageal sphincter affects submucosal oesophageal varices. Lancet II: 1284–1285CrossRefGoogle Scholar
  95. 95.
    Miskowik J, Burcharth F, Jensen L (1981) Effect of lower oesophageal sphincter on oesophageal varices. A portographic study. Scand J Gastroenterol 16: 957–960CrossRefGoogle Scholar
  96. 96.
    Mastai R, Grande L, Bosch J, Bruix J, Rigau J, Kravetz D, Navasa M, Pera C, Rodés J (1986) Effects of metoclopramide and domperidone on azygos venous blood flow in patients with cirrhosis and portal hypertension. Hepatology 6: 1244–1247PubMedCrossRefGoogle Scholar
  97. 97.
    Hosking SW, Doss W, El-Zeiny H, Robinson P, Barsoum MS, Johnson AG (1988) Pharmacological constriction of the lower oesophageal sphincter: a simple method of arresting variceal haemorrhage. Gut 29, 1098–1102PubMedCrossRefGoogle Scholar
  98. 98.
    Braillon A, Capron-Chivrac D, Valla D, Lee S, Capron JP, Lebrec D (1986) Domperidone-induced increase in lower oesophageal sphincter pressure does not affect azygos blood flow in patients with cirrhosis. Scand J Gastroenterol 21: 1080–1082PubMedCrossRefGoogle Scholar
  99. 99.
    Feu F, Mas A, Bosch J, Salmerón JM, García-Pagán JC, Terés J, Rodés J (1988) Domperidone or metoclopramide vs. placebo in the prevention of early variceal rebleeding in cirrhosis. A prospective randomized trial. J Hepatol S1, 7: S31Google Scholar

Copyright information

© Springer Japan 1991

Authors and Affiliations

  • Miquel Navasa
  • Jaime Bosch
  • Joan Rodés
    • 1
  1. 1.Liver Unit, Hospital Clinic i ProvincialUniversity of BarcelonaBarcelonaSpain

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