Terlipressin is more effective in decreasing variceal pressure than portal pressure in cirrhotic patients

Background/Aims: Terlipressin decreases portal pressure. However, its effects on variceal pressure have been poorly investigated. This study investigated the variceal, splanchnic and systemic hemodynamic effects of terlipressin. Methods: Twenty cirrhotic patients with esophageal varices grade II–III, and portal pressure ≥12 mmHg were studied. Hepatic venous pressure gradient, variceal pressure and systemic hemodynamic parameters were obtained. After baseline measurements, in a double-blind administration, 14 patients received a 2-mg/iv injection of terlipressin and six patients received placebo. The same measurements were repeated 60 min later. Results: No demographic or biochemical differences were observed in basal condition between groups. Terlipressin produced significant decreases in intravariceal pressure from 20.9±4.9 to 16.3±4.7 mmHg (p<0.01, −21±16%), variceal pressure gradient from 18.9±4.8 to 13.5±6.0 mmHg (p<0.01, −28±27%), estimated variceal wall tension from 78±29 to 59±31 mmHg • mm (p<0.01, −27±22%), and hepatic venous pressure gradient from 19.4±4.5 to 16.8±5 mmHg (p<0.01, −14±12%) at 60 min. The change in variceal pressure after 60 min of terlipressin administration was greater than the change in wedge hepatic venous pressure (−4.7 mmHg vs −0.5 mmHg, respectively, p<0.0001). Terlipressin also caused significant decreases in heart rate and cardiac index and increases in mean arterial pressure and peripheral vascular resistance. Conclusions: Our results demonstrate that terlipressin produces significant and prolonged decreases in variceal pressure and variceal wall tension and has intrinsic effects on portal pressure and systemic hemodynamics. Variceal pressure provides a better assessment of the effects of terlipressin administration on esophageal varices than hepatic venous pressure gradient.