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HPB Surgery
Volume 11 (1999), Issue 3, Pages 141-150
http://dx.doi.org/10.1155/1999/27037

Do Alterations in the Rate of Gastric Emptying after Injection Sclerotherapy for Oesophageal Varices Play any Role in the Development of Portal Hypertensive Gastropathy?

1Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool, United Kingdom
2Department of Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
3Academic Department of Surgery, Postgraduate Medical School, Morriston Hospital, Swansea, United Kingdom
4Department of Nuclear Medicine, Box. No. 170, Addenbrooke's Hospital, Cambridge CB22QQ, United Kingdom

Received 30 November 1995; Accepted 30 April 1998

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bleeding from portal hypertensive gastropathy (PHG) has been estimated to account for upto 30% of all upper gastrointestinal haemorrhage in patients with cirrhosis and portal hypertension. Although portal hypertension seems to be an essential prerequisite, the precise mechanisms responsible for the development of PHG are unknown. The aim of this study was to examine the role of injection sclerotherapy of oesophageal varices in the development of PHG. Gastric emptying was studied using a radionuclide test meal with the emptying characteristics of a slow liquid in 57 patients with cirrhosis and/or portal hypertension (median age 53 yrs), of whom 34 had received injection sclerotherapy for their oesophageal varices and 20 normal healthy volunteers (median age 42 yrs). As vagal damage is associated with more rapid emptying of liquids, despite hold up of solids, this technique might be expected to demonstrate such damage if gastric emptying was accelerated. The results indicated that there was no difference in the rate of gastric emptying between normal healthy volunteers and portal hypertensive patients. However, patients who had received injection sclerotherapy emptied their stomachs faster than those who had not (p<0.05). Furthermore, the speed of gastric emptying correlated directly 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 that injection sclerotherapy for oesophageal varices results in disturbances of gastric emptying that may contribute to the pathogenesis of portal hypertensive gastropathy.