The stomach in cirrhosis. The legend of Proteus retold

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) (watermelon stomach) are increasingly recognized as separate nosological entities detectable by careful upper gastrointestinal endoscopy and meticulous histological assessment. The have a significant phenomenological overlap; both usually present with gastric mucosal hemorrhage and have a striking association with cirrhosis. However, the distinct endoscopic and histological features, which are discussed in this paper, enable physicians to differentiate PHG from GAVE. Portal hypertension as the prerequisite of PHG necessitates surgical (portosystemic shunting) or medical (beta-blockade) portal decompressive therapy, whereas the angiodysplasia-like lesions in watermelon stomach are successfully treated by electrocoagulation or laser therapy.