Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome

Burak, Kelly W.

doi:10.1136/gut.49.6.866

Cited by 166 publications

(139 citation statements)

References 81 publications

(65 reference statements)

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“…Treatments that reduce portal pressure are effective for PHG but ineffective for GAVE [193] . PHG and GAVE also affect different gastric locations.…”

Section: Dynamic Ct: Kim 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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“…Treatments that reduce portal pressure are effective for PHG but ineffective for GAVE [193] . PHG and GAVE also affect different gastric locations.…”

Section: Dynamic Ct: Kim 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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“…PHG is limited to patients with portal hypertension, whereas GAVE can be seen in a variety of different disorders, including cirrhosis. 85 The effect of TIPS on PHG and GAVE has been examined in several small series. In one report, 75% of patients with severe PHG showed both endoscopic improvement and a decrease in the need for transfusions.…”

Section: Prevention Of Bleeding From Portal Hypertensive Gastropathy mentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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“…[11][12][13] PHT enteropathy may lead to structural changes in the intestinal mucosa in patients with cirrhosis. Macroscopically, the mucosa is oedematous and erythematous because of congestion in the portal venous system.…”

Section: Tropical Gastroenterology 2013;34(3):119-122mentioning

confidence: 99%

Intestinal permeabililty in portal hypertension: Still a dilemma

Makharia¹

2013

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Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome

Cited by 166 publications

References 81 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

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

Intestinal permeabililty in portal hypertension: Still a dilemma

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