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February 5, 1982

Pharmacology of Portal Hypertension: Old Problems and New Ideas

JAMA. 1982;247(5):669-670. doi:10.1001/jama.1982.03320300073033

In this issue of The Journal (p 666), Lambert and colleagues present evidence to include ischemic colitis in the long list of complications associated with vasopressin therapy. This naturally occurring nonapeptide, when infused at pharmacologic doses, will result in generalized arterial vasoconstriction, decreasing (among other regional circulations) mesenteric blood flow. In spite of this generalized effect, vasopressin is used for the treatment of gastrointestinal bleeding caused by portal hypertension.

Vasopressin has been employed for at least two decades and it appears that its use will continue. However, when infused intravenously for treatment of bleeding esophageal varices, the drug is associated with a high rate of failure (20% to 50%)1,2 and dangerous cardiac and intestinal complications. The intestinal ischemia is related to decreased mesenteric blood flow, and to the inability of the intestinal cell to increase oxygen extraction as a response to the reduced flow; this latter phenomenon probably reflects