Effects of intravenous nitroglycerin and nitroglycerin and metoclopramide on intravariceal pressure: a double blind, randomized study.

Abstract

Effective and safe reduction of variceal pressure by pharmacological means. Twenty patients with portal hypertension and large esophageal varices. Ten patients received i.v. nitroglycerin (300 micrograms-bolus) and an equal number received a combination of i.v. nitroglycerin (150 micrograms) and metoclopramide (20-mg bolus). Continuous measurement of variceal pressure and systemic hemodynamics was carried out. Compared with the baseline, the variceal pressure was reduced at 10 min after injection of 300 micrograms nitroglycerin (22.3 +/- 7.9 vs. 17.3 +/- 7 mm Hg, p, not significant); the percentage reduction was 23.5 +/- 15.8%. With the combination of low dose (150 micrograms) nitroglycerin and metoclopramide, variceal pressure significantly decreased from 23.1 +/- 4.7 to 15.9 +/- 5.9 mm Hg (p < 0.01) (a reduction of 29.5 +/- 24.1%). There was no significant alteration in the heart rate or mean arterial pressure with either regimen. Our results suggest that a combination of i.v. metoclopramide and low-dose nitroglycerin reduces variceal pressure more effectively than high-dose nitroglycerin used alone. This combination should be further evaluated in the control of acute variceal bleeding.