[Whole-gut irrigation with mannitol in cirrhotic patients with gastro-intestinal bleeding. Changes in blood ammonia and aminoacids levels (author's transl)]

Abstract

The purpose of the study was to examine the effects of whole gut mannitol irrigation on arterial blood ammonia and plasma aminoacids in cirrhotic patients with bleeding oesophageal varices and its influence on post-haemorrhagic encephalopathy. The 28 patients studied were divided at random into two groups: group I, non-irrigated (n = 16) and group II, irrigated (n = 12). In all cases bleeding was controlled by a Blakemore haemostatic tube which enabled irrigation to be performed in group II subjects. Four hours after starting irrigation a significant decrease in arterial blood ammonia became apparent in group II patients as compared with controls (p < 0.05). After 24 hours, blood ammonia had decreased in both groups but was significantly lower in group II patients than in group I patients (p < 0.01). No significant change in branched chain aminoacids to aromatic aminoacids molar ratio was observed in either group. Clinically, mannitol irrigation had a significantly (p < 0.01) favourable effect in preventing the development or aggravation of posthaemorrhagic encephalopathy, which suggests that toxic substances of intestinal origin, particularly ammonia, may intervene in the pathogenesis of this condition.