Effects of Endoscopic Variceal Ligation on Portal Hypertensive Gastropathy and Gastric Mucosal Blood Flow

Yoshikawa, Ichiro; Murata, Ikuo; Nakano, Shigekazu; Ōtsuki, Makoto

doi:10.1111/j.1572-0241.1998.071_c.x

Cited by 26 publications

(19 citation statements)

References 23 publications

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“…Itha et al [11] concluded that the significant increase in Lo et al [81] 77 patients with bleeding from EV underwent variceal ligation and were randomized to receive propranolol (37/77) Pre vs post ligation, both groups; P < 0.05; frequency of PHG significantly higher in control group post ligation when compared to propranolol group; P = 0.002 de la Peña et al [82] 93 patients with history of variceal hemorrhage and cirrhosis, randomized to receive either EVS (46/88) frequency and severity of PHG after variceal eradication resulted from decreasing collateral blood flow through esophageal varices causing increasing PHG from gastric mucosal congestion. This mechanism is supported by finding that gastric mucosal blood flow increases after variceal ligation [91] . Another theory is that delayed gastric emptying after sclerotherapy from extravasation of sclerosant, may cause development of PHG [69] .…”

Section: Esophageal Variceal Eradicationsupporting

confidence: 69%

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: Esophageal Variceal Eradicationsupporting

confidence: 69%

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

Gjeorgjievski¹

2016

WJH

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“…Moreover, the presence of (2,(9)(10)(11)(12). However, the frequency of gastric varices may increase and PHG may be aggravated after eradication of esophageal varices (5,9,12,13). Both gastric varices and PHG are other important sources of gastrointestinal tract bleeding in portal hypertension patients (10,14).…”

Section: Discussionmentioning

confidence: 97%

“…EVL and EST showed similar results. Moreover, the presence of (2,(9)(10)(11)(12). However, the frequency of gastric varices may increase and PHG may be aggravated after eradication of esophageal varices (5,9,12,13).…”

Section: Discussionmentioning

confidence: 97%

Effects of Esophageal Varice Eradication on Portal Hypertensive Gastropathy and Fundal Varices: A Retrospective and Comparative Study

et al. 2006

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Esophageal varice eradication results in gastric hemodynamic changes. The aim of this study was to detect the influence of variceal eradication on portal hypertensive gastropathy (PHG) and fundal varices and to compare the results of two therapeutic methods (endoscopic variceal ligation and endoscopic sclerotherapy). A total of 114 consecutive patients with cirrhosis and portal hypertension who underwent elective endoscopic variceal ligation (EVL) (85 patients) or endoscopic sclerotherapy (EST) (29 patients) for obliteration of esophageal varices were selected for this study. Both groups were compared for PHG and fundal varice formation before and after eradication. Fifty-eight (68.2%) patients in the EVL and 18 (62.1%) patients in the EST group had PHG before esophageal varice eradication (P > 0.05). PHG grade after eradication of esophageal varices by both EVL and EST was significantly higher compared to pre-eradication. PHG grade and aggregation were similar in both groups. Thirty-seven patients (34 F(1), 3 F(2)) in the EVL group and 13 patients (10 F(1), 3 F(2)) in the EST group had fundal varices before variceal eradication (P > 0.05). Fundal varices were detected in 46 (35 F(1), 11F(2)) and 19 (11F(1), 8F(2)) patients in the EVL and EST groups after eradication, respectively. There was a statistically significant increment in occurrence of fundal varices after eradication with EVL and EST groups. There was no significant difference regarding fundal varice development after esophageal variceal eradication in both groups. After varical eradication, PHG was found in 57 (87.7%) and 39 (79.6%) patients with and without fundal varices, respectively (P > 0.05). Esophageal eradication with EVL and EST increases both the incidence and the severity of PHG and fundal varice formation. Both methods have comparable influences on PHG and fundal varices.

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“…La localización más frecuente es el fundus, seguido por el cuerpo y antro gástrico, aunque las lesiones pueden estar presentes en cualquier parte del tracto digestivo 12,17,18,36 .…”

Section: Diagnósticounclassified

Lesiones vasculares gástricas en la cirrosis: gastropatía y ectasia vascular antral

Casas

Calvet

Vergara

et al. 2015

Gastroenterología y Hepatología

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Effects of Endoscopic Variceal Ligation on Portal Hypertensive Gastropathy and Gastric Mucosal Blood Flow

Cited by 26 publications

References 23 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

Effects of Esophageal Varice Eradication on Portal Hypertensive Gastropathy and Fundal Varices: A Retrospective and Comparative Study

Lesiones vasculares gástricas en la cirrosis: gastropatía y ectasia vascular antral

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