Management of portal hypertensive gastropathy and other bleeding

Abstract

A major cause of cirrhosis related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Less common causes of gastrointestinal bleeding are peptic ulcers, malignancy, angiodysplasia, etc. Upper gastrointestinal bleeding has been classified according to the presence of a variceal or non-variceal bleeding. Although non-variceal gastrointestinal bleeding is not common in cirrhotic patients, gastroduodenal ulcers may develop as often as non-cirrhotic patients. Ulcers in cirrhotic patients may be more severe and less frequently associated with chronic intake of non-steroidal anti-inflammatory drugs, and may require more frequently endoscopic treatment. Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. Patients with portal hypertension may experience bleeding from the stomach, and pharmacologic or radiologic interventional procedure may be useful in preventing re-bleeding from PHG. Gastric antral vascular ectasia (GAVE) seems to be different disease entity from PHG, and endoscopic ablation can be the first-line treatment.

Effect of Endoscopic Argon Plasma Coagulation on Gastrointestinal Blood Loss Due to Portal Hypertensive Gastropathy

“…In our study, the use of beta-blockers is associated with the gradual increase in the mean of hemoglobin, serum iron, and serum ferritin and gradual decrease of TIBC these results were found to be close to those reported by Snyder et al [24].…”

Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis

“…It appears endoscopically as "snakeskin-like appearance" of gastric mucosa and mainly involves body and fundus of the stomach. [1] According to Baveno III consensus, it is classified as mild and severe. Mild PHG is defined as mosaic-like appearance without redness of the areola, while severe PHG is manifested by red marks.…”

Helicobacter pylori Infection in Patients with Portal Hypertensive Gastropathy Owing to Liver Cirrhosis: Prevalence and Relation with Severity of Gastropathy

“…[14] It is reported that 10% of PHGs cause anemia because of the chronic blood loss and 2.5% of patients experienced acute bleeding. [2] The pathogenesis of PHG is likely to be complicated, but PHG seems to occur because of portal hypertension and alteration in gastric microcirculation, which produce mucosal surface hypoxia [15,16] and affect epithelial cell integrity, probably mediated through local factors such as overproduction of nitric oxide, oxygen-free radicals, endothelin-1, TNF-α, and prostaglandins. [17] However, there are other factors associated with the presence and severity of PHG.…”