Do Alterations in the Rate of Gastric Emptyingafter Injection Sclerotherapy for OesophagealVarices Play any Role in the Developmentof Portal Hypertensive Gastropathy?

摘要

Bleeding from portal hypertensive gastropathy(PHG) has been estimated to account for upto 30%of all upper gastrointestinal haemorrhage in patientswith cirrhosis and portal hypertension. Althoughportal hypertension seems to be an essential prerequisite,the precise mechanisms responsible forthe development of PHG are unknown. The aim ofthis study was to examine the role of injection sclerotherapyof oesophageal varices in the developmentof PHG. Gastric emptying was studied using aradionuclide test meal with the emptying characteristicsof a slow liquid in 57 patients with cirrhosisand/or portal hypertension (median age 53 yrs), ofwhom 34 had received injection sclerotherapy fortheir oesophageal varices and 20 normal healthyvolunteers (median age 42 yrs). As vagal damage isassociated with more rapid emptying of liquids,despite hold up of solids, this technique might beexpected to demonstrate such damage if gastricemptying was accelerated. The results indicated thatthere was no difference in the rate of gastricemptying between normal healthy volunteers andportal hypertensive patients. However, patients whohad received injection sclerotherapy emptied theirstomachs faster than those who had not (p<0.05).Furthermore, the speed of gastric emptying correlateddirectly with the number of injections (r=0.41;p=0.02) and the volume of sclerosant injected(r=0.39;p=0.03). These observations suggest thatinjection sclerotherapy for oesophageal varicesresults in disturbances of gastric emptying thatmay contribute to the pathogenesis of portal hypertensivegastropathy.