Portal hypertensive gastropat a clinically significant puzzle

Abstract

SUMMARY
In this review the updated information concerning the influence
of portal hypertension on gastric mucosa is presented.
The term portal hypertensive gastropathy [PHG]
defines a wide spectrum of endoscopic lesions that appear
in the gastric mucosa of cirrhotic patients and which should
be differentiated from gastric antral vascular ectasia. These
endoscopic findings correspond to dilated mucosal and
submucosal vessels in the absence of inflammation. There
is wide variation in the prevalence of PHG, but its natural
history in not clearly documented. Endoscopic variceal obliteration
may contribute to the development or aggravation
of these lesions. Similar influence of portal hypertension
seems to be extended in the lower gastrointestinal tract.
With regard to gastric mucosal hemodynamics, it is not
known whether active congestion or passive congestion causes
gastric mucosal hyperhemia. The pathogenesis of PHG
in not well known, but both venous congestion related to
raised portal pressure and increased gastric blood flow seem
to be crucial factors for its development. Gastric mucosal
defense mechanisms are impaired in PHG. Bleeding is its
unique clinical manifestation and occurs in patients with
severe lesions. Pharmacological, surgical and interventional
radiological procedures are available for the treatment of
bleeding PHG, but the treatment needs to be improved.
Key words: Portal hypertensive gastropathy, portal hypertensive
vasculopathy, liver cirrhosis, portal hypertension