Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.438
Peer-review started: October 28, 2017
First decision: November 14, 2017
Revised: December 1, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: January 21, 2018
Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored. In the acute setting, the PDE-5-inhibitor Vardenafil lowered portal pressure by 13%. The portal blood flow increased by 28% based on Doppler sonography and by 16% using MRI technique. As maintenance medication the PDE-5-inhibitor Tadalafil was used for eight consecutive years with comparable effects on portal pressure and portal blood flow. There were no recurrence of bleeding and no formation of new varices. Influencing the NO-pathway by the use of PDE-5 inhibitors may have long-term beneficial effects in compensated cirrhosis.
Core tip: Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5) reduce portal pressure in the acute setting by > 10%. This is the first report of a patient with liver cirrhosis showing that in long-term treatment with a PDE-5-inhibitor the positive effect on liver hemodynamics is maintained thus preventing further variceal bleeding.