Portal Hypertensive Gastropathy

Abstract

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE), frequently combined, are responsible for acute and chronic bleeding in patients with liver cirrhosis and portal hypertension. Endoscopy is basic for detection of typical features and histological examination can enhance diagnostic accuracy. PHG is frequently responsible for chronic bleeding/anemia and the first treatment option is medical therapy; otherwise, failures can be managed by shunting procedures, such as transjugular intrahepatic portosystemic shunt or surgery. Vasoactive drugs (terlipressin or somatostatin and analogues) can be effectively adopted in less common acute bleeding episodes and additional endoscopic therapy can be performed. Endoscopic hemostatic techniques, like argon plasma coagulation, heater probe and laser, are the first-line treatment for both acute and chronic bleeding from GAVE; preliminary data supported the effectiveness of cryotherapy, radiofrequency and banding ligation as appropriate management options.