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Portal Hypertensive gastropathy
1Gastroenterology Department, Hospital Clínic i Provincial, University of Barcelona, Spain.
Abstract:
The term portal hypertensive gastropathy (PHG) defines a wide spectrum of diffuse macroscopic lesions that appear in the gastric mucosa of patients with portal hypertension. Histologically, these lesions correspond to dilated vessels in the mucosa and submucosa in the absence of erosions or inflammation. Endoscopically, the lesions are classified as mild when mosaic pattern or superficial reddening are present, and severe when gastric mucosa appear with diffuse cherry red spots. Mild lesions are highly prevalent (65-90%), whereas severe lesions are present in only 10-25% of cirrhotic patients. The pathogenesis of PHG is not well known, but both venous congestion related with raised portal pressure and increased gastric blood flow seem to be crucial factors for its development. Variceal sclerosis may contribute to the development or aggravation of the lesions. Bleeding is the unique clinical manifestation of PHG, and occurs only in those patients with severe lesions. During a 5-year follow-up, the risk of overt bleeding or chronic bleeding, which induces anaemia, is 60 % and 90%, respectively, for patients with severe PHG. Propranolol is the only pharmacological treatment that has been proven useful in preventing bleeding from PHG. Porto-systemic shunts and liver transplantation are also effective.
Insights
Portal hypertensive gastropathy (PHG) involves gastric lesions in patients with portal hypertension. Severe PHG significantly increases bleeding risk, but propranolol and shunts can prevent it.
Area of Science:
- Gastroenterology
- Hepatology
- Vascular Medicine
Background:
- Portal hypertensive gastropathy (PHG) presents as diffuse gastric mucosal lesions in patients with portal hypertension.
- Histology shows dilated submucosal and mucosal vessels without inflammation or erosions.
- Endoscopic classification includes mild (mosaic pattern, reddening) and severe (cherry red spots) forms.
Purpose of the Study:
- To define portal hypertensive gastropathy (PHG) and its clinical implications.
- To elucidate the pathogenesis and risk factors associated with PHG.
- To review management strategies for PHG-related bleeding.
Main Methods:
- Review of histological and endoscopic findings in PHG.
- Analysis of prevalence data for mild and severe PHG in cirrhotic patients.
- Evaluation of risk factors, clinical manifestations, and treatment outcomes.
Main Results:
- Mild PHG affects 65-90% of cirrhotic patients; severe PHG affects 10-25%.
- Pathogenesis involves venous congestion and increased gastric blood flow; variceal sclerosis may contribute.
- Severe PHG carries a high risk of overt (60%) and chronic (90%) bleeding over 5 years.
Conclusions:
- Propranolol is the sole proven pharmacological treatment for preventing PHG bleeding.
- Porto-systemic shunts and liver transplantation are effective interventions for PHG management.