Clinical usefulness of the angiotensin II receptor antagonist losartan in patients with portal hypertensive gastropathy

Background/Aims: An elevated portal vein pressure is an important factor in the onset of portal hypertensive gastropathy associated with liver cirrhosis, and propranolol or vasopressin (drugs with a portal hypotensive effect) are used to treat this problem. It has been reported that angiotensin 11 receptor antagonists, which were developed as antihypertensive agents, also have a portal hypotensive effect, but their usefulness for portal hypertensive gastropathy is unclear. In this study, the angiotensin II receptor antagonist losartan was administered to 16 portal hypertensive gastropathy patients, and its clinical usefulness was examined. Methodology: Losartan was administered once a day after breakfast at a dose of 25mg or 50mg. The effect on portal hypertensive gastropathy was evaluated from the endoscopic findings at baseline and after 4 weeks of administration. And changes of portal hemodynamics were monitored by pulse Doppler ultrasonography at baseline and after 4 weeks of administration. Results: Portal hypertensive gastropathy was found to have improved in nine out of 16 patients for an efficacy rate of 56%. The efficacy rate in the 50mg group (n=6) was 83%, and was higher than the rate of 40% in the 25mg group (n=10). The mean portal vein blood flow velocity was found to increase significantly, while the congestion index decreased significantly, supporting evidence of a decrease in portal pressure. Conclusions: Losartan may become one of the effective treatments for portal hypertensive gastropathy in the future.