Portal hypertensive gastropathy
- Don C Rockey, MD
Don C Rockey, MD
- Chairman, Department of Medicine
- Medical University of South Carolina
Portal hypertension most commonly develops in the setting of chronic liver injury with cirrhosis and typically is the result of a combination of an increase in resistance to portal blood flow and an increase in portal blood flow. Other less common causes of portal hypertension include noncirrhotic portal hypertension and extrahepatic portal vein thrombosis. (See "Portal hypertension in adults".)
Clinically significant portal hypertension may lead to complications such as the following:
●Portal hypertensive gastropathy (PHG)
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- Thuluvath PJ, Yoo HY. Portal Hypertensive gastropathy. Am J Gastroenterol 2002; 97:2973.
- Cubillas R, Rockey DC. Portal hypertensive gastropathy: a review. Liver Int 2010; 30:1094.
- Ohta M, Hashizume M, Higashi H, et al. Portal and gastric mucosal hemodynamics in cirrhotic patients with portal-hypertensive gastropathy. Hepatology 1994; 20:1432.
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- Piasecki C, Chin J, Greenslade L, et al. Endoscopic detection of ischaemia with a new probe indicates low oxygenation of gastric epithelium in portal hypertensive gastropathy. Gut 1995; 36:654.
- Iwao T, Toyonaga A, Sumino M, et al. Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology 1992; 102:2060.
- Hou MC, Lin HC, Kuo BI, et al. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology 1995; 21:1517.
- Urrunaga NH, Rockey DC. Portal hypertensive gastropathy and colopathy. Clin Liver Dis 2014; 18:389.
- Pérez-Ayuso RM, Piqué JM, Bosch J, et al. Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet 1991; 337:1431.
- Sarin SK, Shahi HM, Jain M, et al. The natural history of portal hypertensive gastropathy: influence of variceal eradication. Am J Gastroenterol 2000; 95:2888.
- Wollenman CS, Chason R, Reisch JS, Rockey DC. Impact of ethnicity in upper gastrointestinal hemorrhage. J Clin Gastroenterol 2014; 48:343.
- Patwardhan VR, Cardenas A. Review article: the management of portal hypertensive gastropathy and gastric antral vascular ectasia in cirrhosis. Aliment Pharmacol Ther 2014; 40:354.
- Rockey DC. Occult and obscure gastrointestinal bleeding: causes and clinical management. Nat Rev Gastroenterol Hepatol 2010; 7:265.
- Lyles T, Elliott A, Rockey DC. A risk scoring system to predict in-hospital mortality in patients with cirrhosis presenting with upper gastrointestinal bleeding. J Clin Gastroenterol 2014; 48:712.
- Payen JL, Calès P, Voigt JJ, et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology 1995; 108:138.
- Zhou Y, Qiao L, Wu J, et al. Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study. J Gastroenterol Hepatol 2002; 17:973.
- Bruha R, Marecek Z, Spicak J, et al. Double-blind randomized, comparative multicenter study of the effect of terlipressin in the treatment of acute esophageal variceal and/or hypertensive gastropathy bleeding. Hepatogastroenterology 2002; 49:1161.
- Smith LA, Morris AJ, Stanley AJ. The use of hemospray in portal hypertensive bleeding; a case series. J Hepatol 2014; 60:457.
- de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53:762.
- Kamath PS, Lacerda M, Ahlquist DA, et al. Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology 2000; 118:905.
- CLINICAL MANIFESTATIONS
- Diagnostic approach
- Upper endoscopy
- Histologic findings
- DIFFERENTIAL DIAGNOSIS
- Chronic bleeding
- Acute bleeding
- Endoscopic findings
- Management overview
- Primary prophylaxis
- Chronic bleeding
- Acute bleeding
- Refractory bleeding
- SUMMARY AND RECOMMENDATIONS