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Nitric oxide and portal hypertension.
Metab Brain Dis. 2002 Dec; 17(4):311-24.MB

Abstract

In liver cirrhosis, an increase in hepatic resistance is the initial phenomenon leading to portal hypertension. This is primarily due to the structural distortion of the intrahepatic microcirculation caused by cirrhosis. However, similar to other vascular conditions, architectural changes in the liver are associated with a deficient nitric oxide (NO) production, which results in an increased vascular tone with a further increase in hepatic resistance and portal pressure. New therapeutic strategies are being developed to selectively provide the liver with NO, overcoming the deleterious effects of systemic vasodilators. On the other hand, a strikingly opposite process occurs in splanchnic arterial circulation, where NO production is increased. This results in splanchnic vasodilatation and subsequent increase in portal inflow, which contributes to portal hypertension. Systemic blockade of NO in portal hypertension attenuates the hyperdynamic circulation, but its effects increasing hepatic resistance may offset the benefit of reducing portal inflow, thus preventing an effective reduction of portal pressure. Moreover, it cannot be ruled out that NO blockade may have a deleterious action on cirrhosis progression, which raises caution about their use in patients with cirrhosis.

Authors+Show Affiliations

González-Abraldes J
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
García-Pagán JC
No affiliation info available
Bosch J
No affiliation info available

MeSH

AnimalsCollateral CirculationHumansHypertension, PortalLiver CirrhosisNitric OxideNitric Oxide DonorsPortal SystemSplanchnic CirculationVascular ResistanceVasodilation

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

12602508

Citation

González-Abraldes, Juan, et al. "Nitric Oxide and Portal Hypertension." Metabolic Brain Disease, vol. 17, no. 4, 2002, pp. 311-24.
González-Abraldes J, García-Pagán JC, Bosch J. Nitric oxide and portal hypertension. Metab Brain Dis. 2002;17(4):311-24.
González-Abraldes, J., García-Pagán, J. C., & Bosch, J. (2002). Nitric oxide and portal hypertension. Metabolic Brain Disease, 17(4), 311-24.
González-Abraldes J, García-Pagán JC, Bosch J. Nitric Oxide and Portal Hypertension. Metab Brain Dis. 2002;17(4):311-24. PubMed PMID: 12602508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nitric oxide and portal hypertension. AU - González-Abraldes,Juan, AU - García-Pagán,Juan Carlos, AU - Bosch,Jaime, PY - 2003/2/27/pubmed PY - 2003/7/4/medline PY - 2003/2/27/entrez SP - 311 EP - 24 JF - Metabolic brain disease JO - Metab Brain Dis VL - 17 IS - 4 N2 - In liver cirrhosis, an increase in hepatic resistance is the initial phenomenon leading to portal hypertension. This is primarily due to the structural distortion of the intrahepatic microcirculation caused by cirrhosis. However, similar to other vascular conditions, architectural changes in the liver are associated with a deficient nitric oxide (NO) production, which results in an increased vascular tone with a further increase in hepatic resistance and portal pressure. New therapeutic strategies are being developed to selectively provide the liver with NO, overcoming the deleterious effects of systemic vasodilators. On the other hand, a strikingly opposite process occurs in splanchnic arterial circulation, where NO production is increased. This results in splanchnic vasodilatation and subsequent increase in portal inflow, which contributes to portal hypertension. Systemic blockade of NO in portal hypertension attenuates the hyperdynamic circulation, but its effects increasing hepatic resistance may offset the benefit of reducing portal inflow, thus preventing an effective reduction of portal pressure. Moreover, it cannot be ruled out that NO blockade may have a deleterious action on cirrhosis progression, which raises caution about their use in patients with cirrhosis. SN - 0885-7490 UR - https://www.unboundmedicine.com/medline/citation/12602508/Nitric_oxide_and_portal_hypertension_ DB - PRIME DP - Unbound Medicine ER -