Skip to main content
NCBI home page
Gut logoLink to Gut
. 1987 Sep;28(9):1151–1156. doi: 10.1136/gut.28.9.1151

Effect of Valsalva's manoeuvre and hyoscinbutylbromide on the pressure gradient across the wall of oesophageal varices.

S W Hosking 1, P Robinson 1, A G Johnson 1
PMCID: PMC1433222  PMID: 3500098

Abstract

To assess whether Valsalva's manoeuvre might cause variceal bleeding, 22 patients with oesophageal varices were studied. In 12 patients who received no previous treatment to their varices the median pressure gradient across the varix wall at rest was 19 (6-36) mmHg, and in 10 patients whose varices were thrombosed at their distal end the median pressure gradient in the proximal patent varix was 8 (1-6) mmHg. In untreated patients groups, the pressure gradient rose by 6-12 mmHg during Valsalva's manoeuvre in four patients, fell by 4-11 mmHg in five patients and was virtually unchanged in the remainder. These changes seem unlikely to cause variceal bleeding. Patients who repeated Valsalva's manoeuvre showed similar changes on each occasion. Six patients in the untreated group also received hyoscinbutylbromide 20 mg iv. No change was seen in the pressure gradient in five patients, suggesting that it is of little value in preventing variceal bleeding.

Full text

PDF
1151

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bosch J., Bordas J. M., Rigau J., Viola C., Mastai R., Kravetz D., Navasa M., Rodés J. Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy. Hepatology. 1986 Jul-Aug;6(4):667–672. doi: 10.1002/hep.1840060421. [DOI] [PubMed] [Google Scholar]
  2. Britton R. C. Pregnancy and esophageal varices. Am J Surg. 1982 Apr;143(4):421–425. doi: 10.1016/0002-9610(82)90190-8. [DOI] [PubMed] [Google Scholar]
  3. Burcharth F., Bertheussen K. The influence of posture, Valsalva manoeuvre and coughing on portal hypertension in cirrhosis. Scand J Clin Lab Invest. 1979 Nov;39(7):665–669. doi: 10.1080/00365517909108872. [DOI] [PubMed] [Google Scholar]
  4. Burroughs A. K., Jenkins W. J., Sherlock S., Dunk A., Walt R. P., Osuafor T. O., Mackie S., Dick R. Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. N Engl J Med. 1983 Dec 22;309(25):1539–1542. doi: 10.1056/NEJM198312223092502. [DOI] [PubMed] [Google Scholar]
  5. Clements D., Rhodes J. M., Elias E. Effect of somatostatin on oesophageal variceal pressure assessed by direct measurement. J Hepatol. 1986;2(2):262–266. doi: 10.1016/s0168-8278(86)80085-x. [DOI] [PubMed] [Google Scholar]
  6. Dawson J., Gertsch P., Mosimann F., West R., Elias E. Endoscopic variceal pressure measurements: response to isosorbide dinitrate. Gut. 1985 Aug;26(8):843–847. doi: 10.1136/gut.26.8.843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fedail S. S., Harvey R. F., Burns-Cox C. J. Abdominal and thoracic pressures during defaecation. Br Med J. 1979 Jan 13;1(6156):91–91. doi: 10.1136/bmj.1.6156.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Garcia-Tsao G., Groszmann R. J., Fisher R. L., Conn H. O., Atterbury C. E., Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985 May-Jun;5(3):419–424. doi: 10.1002/hep.1840050313. [DOI] [PubMed] [Google Scholar]
  9. Gertsch P., Loup P., Diserens H., Mosimann F., Mosimann R. Endoscopic noninvasive manometry of esophageal varices: prognostic significance. Am J Surg. 1982 Nov;144(5):528–530. doi: 10.1016/0002-9610(82)90573-6. [DOI] [PubMed] [Google Scholar]
  10. Ghahremani G. G., Port R. B., Winans C. S., Williams J. R. Esophageal varices. Enhanced radiologic visualization by anticholinergic drugs. Am J Dig Dis. 1972 Aug;17(8):703–712. doi: 10.1007/BF02231638. [DOI] [PubMed] [Google Scholar]
  11. Jenkins S. A., Baxter J. N., Corbett W., Devitt P., Ware J., Shields R. A prospective randomised controlled clinical trial comparing somatostatin and vasopressin in controlling acute variceal haemorrhage. Br Med J (Clin Res Ed) 1985 Jan 26;290(6464):275–278. doi: 10.1136/bmj.290.6464.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kravetz D., Bosch J., Terés J., Bruix J., Rimola A., Rodés J. Comparison of intravenous somatostatin and vasopressin infusions in treatment of acute variceal hemorrhage. Hepatology. 1984 May-Jun;4(3):442–446. doi: 10.1002/hep.1840040315. [DOI] [PubMed] [Google Scholar]
  13. Lebrec D., De Fleury P., Rueff B., Nahum H., Benhamou J. P. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980 Dec;79(6):1139–1144. [PubMed] [Google Scholar]
  14. Lebrec D., Poynard T., Bernuau J., Bercoff E., Nouel O., Capron J. P., Poupon R., Bouvry M., Rueff B., Benhamou J. P. A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a final report. Hepatology. 1984 May-Jun;4(3):355–358. doi: 10.1002/hep.1840040301. [DOI] [PubMed] [Google Scholar]
  15. McCormack T. T., Rose J. D., Smith P. M., Johnson A. G. Perforating veins and blood flow in oesophageal varices. Lancet. 1983 Dec 24;2(8365-66):1442–1444. doi: 10.1016/s0140-6736(83)90796-1. [DOI] [PubMed] [Google Scholar]
  16. PALMER E. D., BRICK I. B. Correlation between the severity of esophageal varices in portal cirrhosis and their propensity toward hemorrhage. Gastroenterology. 1956 Jan;30(1):85–90. [PubMed] [Google Scholar]
  17. PALMER E. D. Effect of the Valsalva maneuver on portal hypertension in cirrhosis. Am J Med Sci. 1954 Jun;227(6):661–662. doi: 10.1097/00000441-195406000-00010. [DOI] [PubMed] [Google Scholar]
  18. Pellegrini C. A., DeMeester T. R., Skinner D. B. Response of the distal esophageal sphincter to respiratory and positional maneuvers in humans. Surg Forum. 1976;27(62):380–382. [PubMed] [Google Scholar]
  19. Reding P., Urbain D., Grivegnee A., Frere D. Portal venous-esophageal luminal pressure gradient in cirrhosis. Hepatology. 1986 Jan-Feb;6(1):98–100. doi: 10.1002/hep.1840060118. [DOI] [PubMed] [Google Scholar]
  20. Staritz M., Poralla T., Meyer zum Büschenfelde K. H. Intravascular oesophageal variceal pressure (IOVP) assessed by endoscopic fine needle puncture under basal conditions, Valsalva's manoeuvre and after glyceryltrinitrate application. Gut. 1985 May;26(5):525–530. doi: 10.1136/gut.26.5.525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Waldram R., Nunnerley H., Davis M., Laws J. W., Williams R. Detection and grading of oesophageal varices by fibre-optic endoscopy and barium swallow with and without Buscopan. Clin Radiol. 1977 Mar;28(2):137–141. doi: 10.1016/s0009-9260(77)80088-3. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES