[Congestive gastropathy in liver cirrhosis]

Congestive gastropathy has emerged as a new nosological entity that can be included among the complications of advanced liver cirrhosis. It has been defined as the macroscopic changes of gastric mucosa occurring in portal hypertension that are associated with vascular mucosal and submucosal dilatation and ectasia without significant inflammatory changes. The pathogenesis of congestive gastropathy has not been completely cleared up. Many epidemiological and clinical studies and some tests on animals lead most Authors to think that the cause of this disease is a chronic increase of pressure in the portal vascular system. However the involvement of humoral factors cannot be excluded as, for example, the presence of high plasma levels of gastrin and histamine or a decrease of E2 prostaglandin in the gastric mucosa. The macroscopic lesions typical of congestive gastropathy can be seen through endoscopy. Up to now mosaic-like pattern, red points, cherry-red and black-brown spots and erosions have been observed. These changes are prominent in the area near the gastric body and cardias, but can be present in all parts of the stomach. The frequently reported spontaneous bleeding corresponding to cherry-red spots make the presence of these lesions to be considered a sign of severe congestive gastropathy. The prevalence of congestive gastropathy in cirrhotic patients is between 30% and 70%. This condition is more frequent in patients with large esophageal varices and severe liver disease and in patients submitted to endoscopic variceal sclerotherapy. Congestive gastropathy is a frequent cause of acute and chronic bleeding: 10-20% of gastrointestinal bleeding episodes occurring in cirrhotic patients are caused by this condition and about 30% of cirrhotics with portal hypertension will have one or more acute bleeding in a four year follow-up. The percentage of subjects with chronic hemorrhage in the same period can reach 90%. At the moment is not possible to suggest a therapy able to prevent or cure the acute or chronic bleeding associated with congestive gastropathy. beta-blockers seem to be a promising treatment. However, further and larger clinical trials are necessary to settle definitively their efficacy.