Stomach in portal hypertension

Area of Science:

• Gastroenterology
• Hepatology
• Vascular Medicine

Background:

• Portal hypertension is a serious complication of liver disease.
• Portal hypertensive gastropathy (PHG) and gastric varices are common manifestations.
• Understanding their incidence and risk factors is crucial for patient management.

Purpose of the Study:

• To evaluate the incidence of PHG and gastric varices in patients with portal hypertension.
• To compare the occurrence of these conditions across different etiologies of portal hypertension.
• To assess the impact of esophageal varices size on PHG and gastric varices.

Main Methods:

• Prospective evaluation of 365 consecutive patients with portal hypertension (cirrhosis, non-cirrhotic portal fibrosis, extrahepatic portal vein obstruction).
• Assessment of PHG and gastric varices using endoscopic evaluation.
• Analysis of patient data including etiology, esophageal varices size, and sclerotherapy outcomes.

Main Results:

• PHG was present in 56.4% of patients, significantly higher in cirrhotics (60.6%) and those with large esophageal varices.
• Gastric varices occurred in 29.3%, with higher incidence in non-cirrhotic portal hypertension (NCPF and EHPVO) and large esophageal varices.
• Sclerotherapy did not significantly alter the incidence of gastric varices but was associated with a significant increase in PHG (p < 0.001).

Conclusions:

• PHG is more prevalent in cirrhotic patients and those with large esophageal varices.
• Gastric varices are more common in non-cirrhotic portal hypertension.
• Sclerotherapy may exacerbate PHG, highlighting the need for careful management strategies.