Dynamic CT of portal hypertensive gastropathy: significance of transient gastric perfusion defect sign

Kim, T.U.; Kim, S.; Woo, Sung Koo; Lee, J.W.; Lee, T.H.; Jeong, Yohan; Heo, Jeong

doi:10.1016/j.crad.2008.02.003

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…The accuracy was significantly higher in diagnosing PHG in the gastric body (100%) than the fundus (48%) (P = 0.0009). [50] proposed using dynamic CT to diagnose PHG by demonstrating the transient perfusion defect sign, defined as the presence of transient segmental or subsegmental hypo-attenuating mucosa in the gastric fundus or body during hepatic arterial imaging that returns to normal attenuation on portal venous or equilibrium-phase imaging. This sign had a sensitivity of 75%, specificity of 88.6%, positive predictive value of 90%, and negative predictive value of 72.1% for diagnosing PHG in patients with cirrhosis.…”

Section: Yoo Et Almentioning

confidence: 99%

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: Yoo Et Almentioning

confidence: 99%

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

Gjeorgjievski¹

2016

WJH

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“…18 and 19) has sensitivity and specificity of 75% and 88.6%, respectively. 22 Contrast enhancement of the gastric inner layer in the delayed phase could represent gastric mucosal congestion and when seen in patients with portal hypertension suggests PHG. 23 PHG needs to be differentiated from GAVE syndrome.…”

Section: Portal Hypertensive Gastropathy Imagingmentioning

confidence: 99%

“…Gastric endoscopy (D, E) shows a mosaic or snakeskin-like appearance in the fundus and body. Image courtesy: Kim et al22…”

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confidence: 99%

Imaging of Portal Gastroduodenopathy

Helavar

Ramappa

Wali

2021

Journal of Gastrointestinal and Abdominal Radiology

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Portal hypertension is characterized by elevated pressure in portal venous system due to portal resistance due to various causes. The etiologies are either pre-hepatic, hepatic, or post-hepatic. Elevated portal pressure results in varices at various sites some of which are difficult to identify on endoscopy alone. Other manifestations of elevated portal pressure include portal gastropathy, enteropathy, colopathy, gastric antral vascular ectasia, and ascites. Imaging plays an essential role in diagnosis and imaging of various manifestations of portal hypertension by determining the locations of varices and plan the management for same. Endoscopy helps in visualizing mucosal varices but newer imaging modalities give a panoramic extent of the disease in the entire gastrointestinal tract with great specificity and sensitivity. Initially, Barium study was used to determine esophageal or gastric varices, computed tomography provides detailed anatomic information which can be used to plan management. Due to advancement in imaging and interventional techniques, treatment for varices has seen advent of multiple minimally invasive interventional radiological techniques. A brief outlook on anatomical aspect of varices and various recent advances in management of the same has been provided. Overall knowledge of the various imaging manifestations of portal hypertension can be helpful to evaluate prognosis and plan proper management.

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“…The presence of transient segmental or subsegmental hypo-attenuating mucosa in the gastric fundus or body during hepaticarterial imaging that returns to normal attenuation onportal venous called has perfusion defect sign has been described with a sensitivity of 75%, specificity of 88.6% for diagnosing PHG in patients with cirrhosis 24 .…”

Section: Dynamic Ctmentioning

confidence: 99%

Portal Hypertensive Gastropathy: A Comprehensive Review

Shiekh

Kadla

Khan

et al. 2020

IJMBS

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Portal hypertensive gastropathy (PHG) encompasses the gastric mucosal changes occurring in the setting of portal hypertension,both cirrhotic and non-cirrhotic. Its significance lies in causing acute gastrointestinal bleeding and insidious chronic blood loss presenting as iron deficiency anemia. Diagnosis of PHG is straight-forward, made endoscopically often characterized by a mosaic-like pattern resembling ‘snake-skin’, with or without red spots. Treatment of acute GI bleed is hemodynamic stabilization, vasoconstrictor therapy, antibiotic prophylaxis, non-selective beta-blockers. Endoscopic treatment like APC has a small role. In severe cases, TIPS and shunt surgery can be offered. Secondary prophylaxis of PHG bleeding with non-selective b-blockers is recommended. Keywords: Portal hypertension, Gastrointestinal bleeding, Cirrhosis, Beta-blockers

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Dynamic CT of portal hypertensive gastropathy: significance of transient gastric perfusion defect sign

Cited by 9 publications

References 19 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

Imaging of Portal Gastroduodenopathy

Portal Hypertensive Gastropathy: A Comprehensive Review

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