Brindhesha Rasaratnam , MBBS, FRACP; David Kaye , MBBS, FRACP, PhD; Garry Jennings , MBBS, FRACP, MD; Francis Dudley , MBBS, FRACP, MD; Jaye Chin-Dusting, PhD
Rasaratnam B., Kaye D., Jennings G., Dudley F., Chin-Dusting J.; The Effect of Selective Intestinal Decontamination on the Hyperdynamic Circulatory State in Cirrhosis: A Randomized Trial. Ann Intern Med. 2003;139:186-193. doi: 10.7326/0003-4819-139-3-200308050-00008
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Published: Ann Intern Med. 2003;139(3):186-193.
Advanced hepatic cirrhosis, regardless of its cause, is accompanied by a hyperdynamic circulatory state characterized by high cardiac output, low systemic vascular resistance, and low mean arterial pressure (1). This vasodilatory state contributes to the pathogenesis of many complications of chronic liver disease, such as portal hypertension, ascites formation, and the hepatopulmonary and hepatorenal syndromes. The mechanism responsible for the vasodilatory state is thought to be largely due to the increased vascular production of nitric oxide (2, 3).
We hypothesize that in cirrhosis, the overgrowth or translocation of intestinal bacteria results in increased levels of circulating endotoxin or cytokines, such as tumor necrosis factor-α, and enhances nitric oxide production by inducing either nitric oxide synthase II (4) or III (5) expression. Consistent with this hypothesis, we have previously demonstrated (6) that selective intestinal decontamination with the fluoroquinolone antibiotic norfloxacin successfully inhibits some of the nitric oxide–mediated effects that are evident in patients with alcohol-related cirrhosis. We further tested this hypothesis by examining the effects of selective intestinal decontamination using the antibiotic norfloxacin on systemic and regional hemodynamics in a group of cirrhotic patients in a randomized, double-blind, placebo-controlled, crossover study.
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Gastroenterology/Hepatology, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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