Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2018; 24(3): 438-444
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.438
Beneficial long term effect of a phosphodiesterase-5-inhibitor in cirrhotic portal hypertension: A case report with 8 years follow-up
Peter Deibert, Adhara Lazaro, Zoran Stankovic, Denise Schaffner, Martin Rössle, Wolfgang Kreisel
Peter Deibert, Adhara Lazaro, Denise Schaffner, Faculty of Medicine, Institute for Exercise and Occupational Medicine, Department of Medicine, University Hospital, Freiburg 79106, Germany
Zoran Stankovic, Inselspital, Interventional and Pediatric Radiology, Institute of Diagnostic, University of Bern, Bern 3010, Switzerland
Denise Schaffner, Department of Pharmaceutical Biology and Biotechnology, University of Freiburg, Freiburg 79106, Germany
Martin Rössle, Private Praxis, Praxiszentrum, Freiburg 79104, Germany
Wolfgang Kreisel, Faculty of Medicine, Endocrinology and Infectious Diseases, Department of Gastroenterology, Hepatology, University Hospital, Freiburg 79106, Germany
Author contributions: Deibert P and Kreisel W treated the patient and designed the concept of treatment of portal hypertension with PDE-5-inhibitors; Stankovic Z performed the MRI measurements; Deibert P did the sonographic examinations; Rössle M, Kreisel W and Deibert P performed the invasive measurements of HVPG; All authors shared the acquired data; Deibert P, Lazaro A, Schaffner D, Rössle M and Kreisel W drafted the manuscript.
Informed consent statement: The described patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors declared a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Wolfgang Kreisel, MD, Professor, Department of Internal Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg 79106, Germany.
Telephone: +49-761-27034010 Fax: +49-761-27074880
Received: October 27, 2017
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.

Keywords: Portal hypertension, Phosphodiesterase-5, Liver hemodynamics, Doppler sonography, Magnetic resonance imaging, Liver 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.