Portal hypertensive gastric mucosa: an endoscopic study.

Abstract

SUMMARY The endoscopic features of the gastric mucosa in patients with cirrhosis have not been systematically investigated. In these patients, we observed an endoscopic aspect, consisting of multiple small erythematous areas, outlined by a subtle yellowish network (resembling a mosaic), mainly located in the proximal part of the stomach. We tested the value of this sign by comparing two groups: 100 patients with portal hypertension due to cirrhosis, and 300 control patients without signs of liver disease or portal hypertension. This endoscopic pattern was observed in 94 of the patients with cirrhosis, whereas oesophageal varices were seen in 78 only. In contrast, only one patient of the control group had this aspect. Moreover, this sign was also found in seven of eight patients with non cirrhotic portal hypertension, but was seen neither in 100 patients with chronic alcoholism but without liver disease, nor in 10 cirrhotic patients with end-to-side portacaval shunts. These endoscopic changes might be because of mucosal and/or submucosal oedema and congestion highlighting the normal areae gastricae pattern and related to raised portal pressure. We conclude that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause.In patients with cirrhosis, gastrointestinal bleeding related to portal hypertension may be caused by either ruptured oesophageal varices or acute gastric lesions.2 4 Oesophageal varices mucosal changes in these patients are well documented and might have pronostic value.5 In contrast, very little information is available on the gastric mucosa. We observed during upper endoscopic examination, of patients with cirrhosis, multiple erythematous areas, mainly in the fundus, rectangular or diamond-shaped (2-6 mm in diameter), outlined by a delicate white or yellowish network, resembling a mosaic (Figure). Moreover, during emergency endoscopy for upper gastrointestinal bleeding in patients with cirrhosis, we noticed multiple red spots located in the centre of these areas (Figure). The aim of the prospective study described is to determine if this sign has a true significance for the diagnosis of cirrhosis and/or portal hypertension and to test its sensitivity and specificity.

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

“…It should be remembered that these findings are fairly unespecific and that data concerning the accuracy of endoscopy for the diagnosis of PHG are scarce. In this regard, Papazian et al (114) reported sensitivity and specificity of 93% and 99% of endoscopy with biopsies for the detection of the mosaic pattern.…”

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

“…These red spots may be aggregated in linear stripes (watermelon stomach) but may be confluent (honeycomb pattern). 2 By contrast, PHG is observed mostly in the fundus and body of the stomach and is characterized by superficial erythema of an edematous mucosa with cherry-red spots arranged in a mosaic pattern, with or without diffuse bleeding. Both lesions also can be differentiated by pathologic criteria, with a combination of fibrohyalinosis, spindle cell proliferation, vascular ectasia, and thrombi, being highly suggestive of GAVE.…”

Classification of gastric lesions associated with portal hypertension

“…For practical purposes, this condition was defined by Dr D. R. Tiiger (Shefield, UK) at this conference as 'a condition in which there are macroscopic changes of the gastric mumsa associated with mucosal and submucosal vascular ectasia and dilatation, without any significant After reviewing the mucosal biopsy results, they noted that 'gastritis', as defined by mononuclear cell infiltration, was infrequent, while dilatation of the submucosal veins and eaasiaof the mucosal capillaries and venules were characteristic findings. Based on these observations, they fvst used the term 'congestive gastropathy' to replace 'gastritis', while emphasizing the uniqueness of the portal hypertensive gastric muco~a.~ Papazian et d. 6 characterized the prominent endoscopic features of congestive gasnopathy, consisting of a 'mosaic' pattern of a white reticular network outlining erythematous central areas, which mainly appeared in the fimdus. They ascribed this gross appearance of the mucosa to changes in the gastric mimvasculature secondary to portal hypertension.…”