Portal hypertensive gastropathy
Portal hypertensive gastropathy
- Usually affects proximal stomach
- Unlike variceal hemorrhage, bleeding from portal hypertensive gastropathy is not amenable to endoscopic treatment because of the diffuse nature of the mucosal abnormalities.
- The underlying pathology involves elevated portal venous pressures, so pharmacologic therapy aimed at reducing portal venous pressure is indicated.
- If pharmacologic therapy fails to control acute bleeding, TIPS should be considered
Exam Question
- Portal hypertensive gastropathy (PHG) is the ectatic blood vessels in the proximal gastric body and cardia causing oozing of the blood.
- Less severe grades of PHG appear as a mosaic or snakeskin pattern and are not associated with bleeding.
- Severe PHG with diffuse bleeding is treated by β-adrenergic receptor blockers or possibly with placement of a TIPS or surgical portacaval shunt.
- The best treatment is liver transplantation
Classification of Portal Hypertensive Gastropathy
|
McCormack |
Tanoue |
NIEC = New Italian Endoscopic Club. |
|
Mild |
Grade I |
Mosaic pattern |
|
Fine pink speckling (scarlatina-type rash) |
Mild reddening |
Mild: diffuse pink areola |
|
Superficial reddening |
Congestive mucosa |
Moderate: flat red spot in the pink areola |
|
Mosaic pattern |
|
Severe: diffuse red areola |
|
Severe |
Grade II |
Red mark lesion |
|
Discrete red spots |
Severe redness and a fine reticular pattern separating the areas of raised edematous mucosa |
Discrete |
|
Diffuse hemorrhagic lesion |
|
Confluent (diffuse) |
|
|
Grade III |
Black brown spot |
|
|
Point bleeding + grade II |
|
NIEC = New Italian Endoscopic Club.
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