Roberto J. Groszmann, M.D.

Professor
Section of Digestive Diseases

Research Interests

The most common and lethal complications of cirrhosis are related to the development of portal hypertension. Half of the deaths from cirrhosis are related to gastrointestinal bleeding due to portal hypertension. The studies performed in our laboratory on different models of portal hypertension as well as in patients with chronic liver diseases and portal hypertension, allow us to focus on those questions that are key to a thorough understanding to the pathophysiology of portal hypertension and its logical treatment. Contributions from our laboratory to the field of portal hypertension have included recognition of 1) the significance of increased splanchnic blood flow in contributing to the severity of portal hypertension, 2) the role of plasma volume expansion in aggravating the severity of portal hypertension, 3) the role of nitric oxide in portal hypertension 4) the development of new animal models and techniques for studying the pathophysiology and effects of therapy in portal hypertension. In the clinical area, 1) the mechanisms leading to variceal rupture, 2) the introduction of nitrates to the treatment of portal hypertension, 3) the potential benefits of various drugs combinations in treating portal hypertensive patients and 4) clinical trials in order to explore the knowledge acquired in the laboratory.

During the course of training, the research fellow becomes familiar with techniques to study splanchnic and systemic hemodynamics in patients and animal models of portal hypertension. Also, they become proficient in principles and techniques to study vascular physiology and pathophysiology at the cellular as well as the molecular level, in the portal and intrahepatic circulation. Fellows interested in clinical research can become involved in the organization and development of multicenter clinical trials.

Clinical Interests

Acute and chronic liver diseases with special interest in the treatment of complications of portal hypertension.

Selected Publications

• Nagula S, Jain D, Groszmann RJ, Garcia-Tsao G. Histological hemodynamic correlation in cirrhosis – a histological classification of the severity of cirrhosis. J Hepatol 2006 Jan;44(1):111-117.
• Groszmann RJ, Abraldes JG. Portal hypertension: from bedside to bench. J Clin Gastroenterol. 2005 Apr;39(4 Suppl 2):S125-30.
• Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs AK, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS, and Hong Gao for the Portal Hypertension Collaborative Group. Beta-Blockers to Prevent Gastroesophageal Varices in Patients With Cirrhosis. New England Journal of Medicine, 353(21) Nov 24, pp 2254-2261; 2005.
• Yasuko Iwakiri and Roberto J Groszmann. The Hyperdynamic Circulation of Chronic Liver Diseases: From the Patient to the Molecule. Hepatology (Special Anniversary Issue) 43(S1); S121-S131, 2006.
• Mauricio Silva, Yasuko Iwakiri, Juan G Abraldes, Omar Haq and Roberto J Groszmann. Increased phosphodiesterase-5 expression is involved in the decreased vasodilator response to nitric oxide in cirrhotic rat livers. J Hepatology 44(5):886-893, 2006.
• Juan G. Abraldes, Yasuko Iwakiri, Mauricio Loureiro-Silva, Omar Haq, William C. Sessa, and Roberto J. Groszmann. Mild increases in portal pressure upregulate vascular endothelial growth factor and endothelial nitric oxide synthase in the intestinal microcirculatory bed leading to a hyperdynamic state. American Journal of Physiology: Gastrointestinal and Liver Physiology 290: G980-G987, 2006.
• Shneider B, Emre S, Groszmann R, Karani J, McKiernan P, Sarin S, Shashidhar H, Squires R, Superina R, de Ville de Goyet J, deFranchis R. Portal hypertension in children: Expert pediatric opinion on the report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Pediatr. Transplantation. 10:893-907, 2006.
• Yasuko Iwakiri, Ayano Satoh, Subro Chatterjee, Vijay Shah, Cecile Chalouni, Derek Toomre, David Fulton, Roberto J. Groszmann, and William C. Sessa. Nitric Oxide Synthase Generates Nitric Oxide Locally to Regulate Compartmentalized Protein S-nitrosylation and Protein Trafficking. Proc Natl Acad Sci USA Dec 14;103(52):19777-82. 2006.
• Kwon SY, Groszmann RJ, Iwakiri Y. Increased neuronal nitric oxide synthase interaction with soluble guanylate cyclase contributes to the splanchnic arterial vasodilation in portal hypertensive rats. Hepatol Res Jan;37(1):58-67, 2007.
• Lim J and Groszmann, R. Transient Elastography for Diagnosis of Portal Hypertension in Liver Cirrhosis: Is There Still a Role for HVPG Measurement? Editorial Hepatology 45(5); 1087-1090, 2007. 11) Iwakiri Y and Groszmann RJ. Vascular endothelial dysfunction in cirrhosis. Review J Hepatology 46(5); 927-934, 2007.
• Ripoll C, Groszmann R, Garcia-Tsao G, Bosch J, Grace N, Burroughs AK, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS and the Portal Hypertension Collaborative Group. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients with Compensated Cirrhosis. Gastroenterology Aug; 133(2):481-488, 2007.
• Lee CH, Loureiro-Silva MR, Abraldes JG, Iwakiri Y, Haq O, Groszmann RJ. Decreased intrahepatic response to alpha(1)-adrenergic agonists in lipopolysaccharide-treated rats is located in the sinusoidal area and depends on Kupffer cell function. J Gastroenterol Hepatol. 2007 Jun;22(6):893-900. Epub 2007 May 13.
• Qamar AA, Grace ND, Groszmann RJ, Garcia-Tsao G, Bosch J, Burroughs AK, Maurer R, Planas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Makuch R; Portal Hypertension Collaborative Group. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis. Hepatology. 2008 Jan;47(1):153-9.

Contact

Campus Address
Department of Internal Medicine
333 Cedar Street (LMP 92)
New Haven, CT 06520

E-mail
roberto.groszmann@yale.edu

Office Phone
(203) 785-4795