Effect of Transjugular Intrahepatic Portosystemic Shunt Formation on Portal Hypertensive Gastropathy and Gastric Circulation

Mezawa, Shinichi; Homma, Hisato; Ohta, Hidetoshi; Masuko, Eiichi; Doi, Tadashi; Miyanishi, Koji; Kukitsu, Takehiro; Sato, Tsutomu; Niitsu, Yoshiro

doi:10.1111/j.1572-0241.2001.03694.x

Cited by 70 publications

(39 citation statements)

References 26 publications

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“…As discussed below, other data supporting an association between PHG and portal hypertension include resolution of PHG after intervention to decrease portal hypertension, including pharmacotherapy [74][75][76][77][78] , transjugular intrahepatic portosystemic shunt (TIPS), or liver transplantation [74] . Contrariwise, a decided minority of studies showed no significant association between severity of portal hypertension and rate of PHG [8,9,16,26,28,30,31,47,54,67] .…”

Section: (50%) Not Reported Not Reportedmentioning

confidence: 99%

“…Makhija et al [118] described in PHG a decrease in gastric mucosal blood flow, an increase in the submucosal and muscular layer blood flow, and a net increase in total gastric blood flow. Mezawa et al [76] using a laser Doppler flowmeter to measure gastric mucosal blood flow and near-infrared endoscopy to measure total gastric blood flow, reported decreased mucosal blood flow and increased total blood flow in patients with PHG. These results reversed after undergoing TIPS, with an increase in mucosal blood flow and a decrease in total blood flow.…”

Section: Pathogenesismentioning

confidence: 99%

“…Most studies reported decreased mucosal blood flow in patients with PHG [76,[128][129][130][131] , whereas several studies reported increased gastric mucosal blood flow in experimental animals and in humans with PHG [132][133][134][135][136] . Makhija et al [118] described in PHG a decrease in gastric mucosal blood flow, an increase in the submucosal and muscular layer blood flow, and a net increase in total gastric blood flow.…”

Section: Pathogenesismentioning

confidence: 99%

“…Table 5 [8, 9,11,14,34,41,55,62,67,71,83,85] lists wellestablished risk factors for PHG; Table 6 [11,41, 44,55,[75][76][77]83,85,[98][99][100][101][102][103][104][105][106][107] lists therapies that affect the severity of PHG or the risk of bleeding from PHG, and Table 7 [8, 14,28,30,35,42,84,[108][109][110] lists the factors that do not affect the risk of PGH.…”

Section: Additional Risk Factorsmentioning

confidence: 99%

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Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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Section: (50%) Not Reported Not Reportedmentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Additional Risk Factorsmentioning

confidence: 99%

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Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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“…PHG is mainly detected in patients with more advanced liver disease and in those previously receiving endoscopic haemostatic treatment for EV and GV (prevalence 11-80%) [129,130]. Incidence of acute bleeding and related mortality are quite low (3% and 12.5% at three years, respectively) [131][132][133].…”

Section: Tips Is Not Indicated For the Prophylaxis Of First Variceal mentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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Management of Upper Gastrointestinal Hemorrhage Related to Portal Hypertension

Woreta

2015

Yamada' S Textbook of Gastroenterology

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Effect of Transjugular Intrahepatic Portosystemic Shunt Formation on Portal Hypertensive Gastropathy and Gastric Circulation

Abstract: It is considered that TIPS may have a beneficial effect on PHG at least for a short time. The mechanism by which PHG improves may be closely related to the improvement of the injured gastric perfusion in cirrhotic patients with PHG.

Cited by 70 publications

References 26 publications

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Consensus conference on TIPS management: Techniques, indications, contraindications

Management of Upper Gastrointestinal Hemorrhage Related to Portal Hypertension

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