Drug Therapy for Acute Bleeding From Portal Hypertensive Gastropathy

Gastric mucosal perfusion is increased in portal-hypertensive gastropathy, and this may contribute to gastric bleeding from these lesions. Therefore drugs reducing gastric mucosal perfusion may be beneficial in the treatment of overt bleeding from portal-hypertensive gastropathy. In this study gastric mucosal perfusion was assessed in 28 cirrhotic patients with portal-hypertensive gastropathy under basal conditions and after double-blind intravenous administration of vasopressin (0.4 Ulmin), glypressin (2-mg injection) or placebo, with laser-Doppler flowmetry and reflectance spectrophotometry. Vasopressin and glypressin induced a significant increase in blood pressure and a decrease in heart rate, These effects were more pronounced in the vasopressin group. Both vasopressin and glypressin induced a sustained and similar reduction in gastric mucosal perfusion as assessed by laser-Doppler flowmetry (-36% + 8% and-34% + 6%, respectively; p < 0.05 with respect to basal values and with respect to the control group). Whereas placebo had no effect. Both drugs significantly reduced the oxygen content ofthe gastric mucosa; however, the impairment in mucosal oxygenation was greater (p < 0.05) in the vasopressin group (-17% + 3%) than in the glypressin group (-6% + 0.1%). We conclude that the increased gastric-perfusion in cirrhotic patients with portalhypertensive gastropathy may be reduced by either vasopressin or glypressin. These findings support the use of these drugs in clinical trails treating bleeding portal-hypertensive gastropathy. The lower reduction in gastric mucosal oxygen content observed with glypressin could decrease the incidence ofischemic adverse events associated with the use ofvasopressin. (HEPATOLOGY 1994; 19: 55-60.)