Gastric motility in patients with presinusoidal portal hypertension

The aim of this study was to evaluate the consequences of portal hypertension (PH) for the motor functions of the human stomach.

The PH model used was the hepatosplenic form of mansonic schistosomiasis, as this is a condition characterized by PH but with considerably preserved hepatocellular function. The study included 15 patients with PH and 25 healthy volunteers who served as controls. The adaptive relaxation of the stomach was studied in 12 patients with PH and in 10 controls by a manometric method during rapid insufflation (25-30 s) of 700 ml of air into the gastric fundus. The gastric emptying of a liquid solution (15 patients with PH and 20 controls) and of a solid-liquid meal (nine patients with PH and 12 controls) was determined by gamma scintigraphy. The thickness of the gastric antrum wall was measured by ultrasonography in 12 patients with PH and in 10 controls.

Patients with PH showed the following: 1) reduction of the adaptive relaxation of the stomach (p < 0.0001); 2) acceleration of gastric emptying of the test solution (T 1/2, p = 0.0316), which became particularly expressive 25, 30, 40, and 50 min after ingestion (p = 0.0181, 0.0215, 0.0181, and 0.0215, respectively); 3) no alteration in gastric emptying of the solid-liquid meal as judged by T 1/2 values (p = 0.9170) or lag-phase values (p = 0.7544); and 4) a conspicuous increase in gastric wall thickness as determined by antrum wall measurements (p = 0.0008).

The reduced gastric adaptive relaxation demonstrated in patients with PH and normal hepatocellular function leads us to consider this condition as a cause of diastolic dysfunction of the stomach. In this disease, the motor alteration may be explained as a consequence of the reduction of gastric wall compliance, probably resulting from edema and vascular ectasia, which were indirectly detected by the increase thickness of the gastric antrum wall. The discrete acceleration of liquid gastric may be also related to the reduced gastric wall compliance.