Is ascites caused by impaired hepatic inactivation of blood borne endogenous opioid peptides?

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“…We have proposed a similar hypothesis ( 2 ) , initially 2 years earlier ( 3 ) . In addition, we have found that the opioid peptides methionine enkephalin (2) and leucine enkephalin ( 4 ) are raised considerably in the plasma of patients wit,h cirrhosis. These peptides are potent vasodilators whose receptor sites include splanchnic blood vessels (2,5).…”

“…In addition, we have found that the opioid peptides methionine enkephalin (2) and leucine enkephalin ( 4 ) are raised considerably in the plasma of patients wit,h cirrhosis. These peptides are potent vasodilators whose receptor sites include splanchnic blood vessels (2,5). We therefore suggested that these enkephalins, and possibly other opioid peptides 01' octapeptide size or less (2,6 ) .…”

“…These peptides are potent vasodilators whose receptor sites include splanchnic blood vessels (2,5). We therefore suggested that these enkephalins, and possibly other opioid peptides 01' octapeptide size or less (2,6 ) . cause or contribute to the vasodilatation of liver disease, thereby initiating increased sympathetic tone.…”

Ascites Formation in Liver Cirrhosis: The How and the Why

“…It is a potent vasodilator, and methionine enkeph alin receptors are located in most blood ves sels. Recently, Thornton et al [53] found 5-7 times increased circulating levels of methi onine enkephalin in patients with cirrhosis and ascites compared to those without as cites and to controls. Moreover, plasma en kephalin was directly related to circulating catecholamines, and these authors postu lated a causal relationship to ascites forma tion and vasodilatation.…”

The pruritus of cholestasis is relieved by an opiate antagonist: is this pruritus a centrally mediated phenomenon?

“…Thornton et al 3 report elevated serum levels of opioid for a double-blind, randomized, controlled study using outcome measures that are reliable and well validated. peptides in patients with liver disease and measured their loss in both bile and urine.…”