Treatment for gastric mucosal damage in patients with liver cirrhosis

非糜烂性胃粘膜病变常见于门静脉高压症患者，是急性或慢性消化道出血的表现。这种独特的情况被称为“门脉高压性胃病”或“充血性胃病”。最近的一系列研究表明，PHG患者胃粘膜微循环受损，导致出血和胃溃疡并发症。因此，我们的研究重点是PHG.1的管理。门静脉血流动力学：在PHG患者中，可能存在发育不良的门静脉外分流，门静脉压力较高，胃粘膜灌注较低。动脉外门静脉系统分流患者经硬化治疗后PHG未见加重，这一事实支持了这一假设。加压素+尼卡地平可显著降低游离门静脉压力和门静脉压力梯度。这些效果与单用抗利尿激素的变化相似。抗利尿激素降低肝脏血流量和吲哚菁绿的内在清除。因此，尼卡地平的加入改善了抗利尿激素引起的肝功能损害，但没有进一步降低门静脉压力。硝酸甘油可降低肝硬化患者和门静脉高压症患者的门静脉压力，特别是有门静脉系统侧枝的患者，并可减少门静脉高压症患者的胃粘膜充血。在肝胃相关的思想中，胃粘膜的局部治疗也很重要。戊酰丙酮显著增加胃黏膜灌流，乙酸乙酯显著增加胃黏膜灌流。门静脉降压药物与胃粘膜局部药物联合应用是有待进一步评价的课题。

Non-erosive gastric mucosal lesions are frequently observed in patients with portal hypertension, and represents acute or chronic GI bleeding. This unique condition has been termed as "portal hypertensive gastropathy (PHG)" or "congestive gastropathy. Recent series of studies have shown that the microcirculation on gastric mucosa in patients with PHG is impaired, and that this gives rise to bleeding and gastric ulcer complications. Thus our studies were conducted focusing on management of PHG.1. Portal hemodynamics : In patients with PHG,poorly developed extravariceal portosystemic shunts with higher portal pressure can be expected, in whom a lower gastric mucosal perfusion could be found. The fact that PHG after aclerotherapy shows no aggravation in patients with major extravariceal portosystemic shunt can support this hypothesis.2. Vasopressin+Nicardipine induced a significant reduction in both free portal pressure and the portal venous pressure gradient. These effects were similar to the changes with vasopressin alone. Vasopressin decreased both hepatic blood flow and intrinsic clearance of indocyanine green. Consequently the additio of nicardipine improves hepatic impairment induced by Vasopressin but causes no further reduction on portal pressure.3. Nitroglycerin reduces portal venous pressure in cirrhotic patients and portal hypertension, particularly in those with major porto-systemic collaterals, and reduces the congestion of the gastric mucosa in patients with portal hypertension.4. In the idea of liver-stomach correlation, local treatment for gastric mucosa is also important. Teprenylaceton caused significant mucous production and cetraxate produced significant increase of gastric mucosal perfusion.Combination of portal pressure lowering drugs and local drugs for gastric mucosa is relevant subject for further evaluation.