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Portal hypertensive gastropathy

D E Bernstein¹, R S Phillips

¹Division of Hepatology, University of Miami School of Medicine, Florida, USA.

Gastrointestinal Endoscopy Clinics of North America

|October 1, 1996

Summary

Portal hypertensive gastropathy (PHG) causes upper gastrointestinal bleeding in advanced liver disease. Effective treatment involves reducing portal pressure, not endoscopic variceal therapy.

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Area of Science:

Gastroenterology
Hepatology
Vascular Medicine

Background:

Portal hypertensive gastropathy (PHG) is a recognized complication of advanced liver disease.
It is a significant cause of upper gastrointestinal bleeding in patients with portal hypertension.
The exact pathogenesis is linked to portal hypertension but requires further elucidation.

Purpose of the Study:

To describe the characteristics, presentation, and management of portal hypertensive gastropathy.
To differentiate PHG from variceal bleeding in patients with portal hypertension.

Main Methods:

Review of endoscopic findings, including the characteristic "snake skin" mucosal pattern.
Analysis of gastric biopsies showing vascular congestion.
Clinical observation of PHG presentation and response to therapies.

Main Results:

PHG presents as acute or chronic gastrointestinal bleeding.
Endoscopic sclerotherapy and band ligation for esophageal varices can worsen PHG.
Gastric biopsies reveal vascular congestion, and endoscopy shows a "snake skin" pattern.

Conclusions:

PHG is a distinct vascular disorder requiring management focused on reducing portal pressure.
Treatment strategies include beta-blockers, shunting procedures, or liver transplantation.
Unlike variceal bleeding, PHG does not respond to sclerotherapy or band ligation.

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