Methylene Blue and Cirrhosis: Pathophysiologic Insights, Therapeutic Dilemmas
Authors: Michael B. Fallon
Journal: Annals of Internal Medicine (2000)

Editorials7 November 2000Methylene Blue and Cirrhosis: Pathophysiologic Insights, Therapeutic DilemmasMichael B. Fallon, MDMichael B. Fallon, MDDr. Fallon: University of Alabama at Birmingham; Birmingham, AL 35294-0007Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-9-200011070-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Widespread changes in vascular tone accompany the development of cirrhosis and portal hypertension and contribute to the onset of end-organ complications of liver disease (1). The pulmonary vasculature may be affected, and both vasoconstriction in resistance vessels (which leads to portopulmonary hypertension in approximately 1% to 2% of patients with cirrhosis) (2) and, more commonly, vasodilation in the microcirculation (which leads to the hepatopulmonary syndrome in 8% to 15% of patients with cirrhosis) have been observed. The hepatopulmonary syndrome is defined by intrapulmonary microvascular vasodilation that results in abnormal arterial oxygenation (3). Although the natural history of the syndrome has ...References1. Groszmann RJ. Hyperdynamic circulation of liver disease 40 years later: pathophysiology and clinical consequences. Hepatology. 1994;20:1359-63. CrossrefMedlineGoogle Scholar2. Mandell MS, Groves BM. Pulmonary hypertension in chronic liver disease. Clin Chest Med. 1996;17:17-33. CrossrefMedlineGoogle Scholar3. Rodriguez-Roisin R, Agusti AG, Roca J. The hepatopulmonary syndrome: new name, old complexities. Thorax. 1992;47:897-902. 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Effect of liver transplantation. Clin Chest Med. 1996;17:115-23. CrossrefMedlineGoogle Scholar9. Schenk P, Madl C, Rezaie-Majd S, Lehr S, Müller C. Methylene blue improves the hepatopulmonary syndrome. Ann Intern Med. 2000;133:701-6. LinkGoogle Scholar10. Moncada S, Palmer RM, Gryglewski RJ. Mechanism of action of some inhibitors of endothelium-derived relaxing factor. Proc Natl Acad Sci U S A. 1986;83:9164-8. CrossrefMedlineGoogle Scholar11. Marczin N, Ryan US, Catravas JD. Methylene blue inhibits nitrovasodilator- and endothelium-derived relaxing factor-induced cyclic GMP accumulation in cultured pulmonary arterial smooth muscle cells via generation of superoxide anion. J Pharmacol Exp Ther. 1992;263:170-9. MedlineGoogle Scholar12. Rolla G, Bucca C, Brussino L. Methylene blue in the hepatopulmonary syndrome [Letter]. N Engl J Med. 1994;331:1098. CrossrefMedlineGoogle Scholar13. Martin PY, Gines P, Schrier RW. Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med. 1998;339:533-41. CrossrefMedlineGoogle Scholar14. Chang SW, Ohara N. Increased pulmonary vascular permeability in rats with biliary cirrhosis: role of thromboxane A2 . Am J Physiol. 1993;264 3 Pt 1 L245-52. MedlineGoogle Scholar15. Gupta TK, Chen L, Groszmann RJ. Pathophysiology of portal hypertension. Clinics in Liver Disease. 1997;1:1-12. CrossrefMedlineGoogle Scholar16. Fang FC. Perspectives series: host/pathogen interactions. Mechanisms of nitric oxide-related antimicrobial activity. J Clin Invest. 1997;99:2818-25. CrossrefMedlineGoogle Scholar17. Clemens MG. Nitric oxide in liver injury. Hepatology. 1999;30:1-5. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Fallon: University of Alabama at Birmingham; Birmingham, AL 35294-0007Corresponding Author: Michael B. Fallon, MD, University of Alabama at Birmingham, 410 Lyons Harrison Research Building, 701 South 19th Street, Birmingham, AL 35294-0007; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMethylene Blue Improves the Hepatopulmonary Syndrome Peter Schenk , Christian Madl , Shahrzad Rezaie-Majd , Stephan Lehr , and Christian Müller Methylene Blue Improves the Hepatopulmonary Syndrome David A. 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Groneberg, MD and Axel Fischer, MDMethylene Blue Improves the Hepatopulmonary SyndromePeter Schenk, MD, Stephan Lehr, and Christian Müller, MDPulmonary Complications Associated with Portal Hypertension 7 November 2000Volume 133, Issue 9Page: 738-740KeywordsCirrhosisLiver diseasesMethylene blueNitric oxidePathogenesisPortal hypertensionPulmonary vascular resistanceSystemic vascular resistanceVasoconstrictionVasodilation ePublished: 7 November 2000 Issue Published: 7 November 2000 CopyrightCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...