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Liver involvement in hereditary hemorrhagic telangiectasia: can breath test unmask impaired hepatic first-pass effect?

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Abstract

Hepatic arteriovenous malformations (HAVMs) in hereditary hemorrhagic telangiectasia (HHT) have long been considered to have scarce clinical significance in most cases. Nevertheless, data are lacking regarding the influence of HAVMs on the liver first-pass effect on drugs in HHT patients. To gain insight into the effect of HAVMs on hepatic drug clearance by means of two specific 13C-labeled probes, namely the 13C-methacetin and 13C-aminopyrine, 46 HHT patients and 44-matched healthy controls were enrolled. The liver first-pass effect was studied by the 13C-based breath test using methacetin and aminopyrine. The methacetin breath test showed statistically significant reduced metabolism rates (p < 0.0001) in HHT when compared with controls, both in patients with and without CT-detectable HAVMs, and when expressed both as cumulative 13C-percentage dose per hour and as 13C-percentage peak after 15 min. In contrast, no significant difference was found between HHT and controls regarding aminopyrin metabolism rates. In HHT, 13C%-methacetin breath test values are significantly lower than those found in normal subjects, probably due to the effect of hepatic shunts. A reduced perfusion and an impaired hepatic metabolism might affect hepatic drug clearance in HHT. Therefore, an appropriate dosage adjustments should be considered when high-hepatic-metabolism drugs are administered to HHT patients.

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Abbreviations

HHT:

Hereditary hemorrhagic telangiectasia

HAVMs:

Hepatic arteriovenous malformations

13C-%P15:

Percentage 13CO2 peak value after 15 min

13C-%CPH:

Percentage 13CO2 cumulative dose per hour data

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Acknowledgments

This study was funded in part by Italian Ministry of University and Technology (MIUR, project PRIN2004065303_002) and by Fondazione CARIME.

Conflict of interest

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Authors and Affiliations

  1. Department of Emergency Medicine, Catholic University of Sacred Heart, Rome, Italy

    Marcello Candelli

  2. Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy

    Maurizio Pompili, Giulia Bosco, Gian Ludovico Rapaccini & Antonio Gasbarrini

  3. Geriatric Unit and Rare Disease Center, Department of Internal Medicine and Public Health, University of Bari “A. Moro”, Policlinico, P.zza Giulio Cesare, 11, 70124, Bari, Italy

    Patrizia Suppressa, Gennaro M. Lenato & Carlo Sabbà

  4. Department of Radiological Diagnostics, University of Bari “A. Moro”, Bari, Italy

    Arnaldo Scardapane

Authors
  1. Marcello Candelli
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  2. Maurizio Pompili
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  3. Patrizia Suppressa
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  4. Gennaro M. Lenato
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  5. Giulia Bosco
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  6. Gian Ludovico Rapaccini
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  9. Carlo Sabbà
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Correspondence to Carlo Sabbà.

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Candelli, M., Pompili, M., Suppressa, P. et al. Liver involvement in hereditary hemorrhagic telangiectasia: can breath test unmask impaired hepatic first-pass effect?. Intern Emerg Med 7, 323–329 (2012). https://doi.org/10.1007/s11739-011-0531-9

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  • DOI: https://doi.org/10.1007/s11739-011-0531-9

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