Portal Hypertensive Gastropathy

Abstract

Portal hypertensive gastropathy (PHG) is part of a complex syndrome which occurs as a complication of chronic liver disease and portal hypertension (PHTN). At endoscopy, the gastric mucosa shows that mosaic-like pattern and red marks, which are the source of gastric bleeding. Only the severe form of gastropathy is liable to bleed. The pathogenesis of PHG and the hemodynamic changes in PHTN are not completely understood, but chronic increase in portal pressure is a prerequisite for the development of this disorder. It has been suggested that an overproduction of endogenous vasodilators and a reduced vascular sensitivity to endogenous vasoconstrictors contribute to these circulatory disturbances. H₂ receptor antagonists and sucralfate are ineffective in the management of bleeding PHG. Two small studies reported that propranolol is effective in arresting mucosal hemorrhage from severe PHG. Other feasible alternatives include transjugular intrahepatic portal-systemic shunt (TIPS) and portal-systemic shunt procedure.

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

“…As discussed below, other data supporting an association between PHG and portal hypertension include resolution of PHG after intervention to decrease portal hypertension, including pharmacotherapy [74][75][76][77][78] , transjugular intrahepatic portosystemic shunt (TIPS), or liver transplantation [74] . Contrariwise, a decided minority of studies showed no significant association between severity of portal hypertension and rate of PHG [8,9,16,26,28,30,31,47,54,67] .…”

“…Proton pump inhibitors, sucralfate [74] , and histamine-2 receptor antagonists are not very effective at reducing bleeding from PHG because most patients with PHG already have hypochlorhydria [79,106,[240][241][242] . However, proton pump inhibitors may indirectly stop bleeding from the stomach by raising intraluminal gastric pH and thereby stabilizing blood clots [243,244] .…”

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

“…Clearly, H 2 blockers and sucralfate are ineffective in the treatment of PHG 47. This may be due to the fact that some patients with PHG are hypochlorhydric 47. The most important pharmacotherapy for PHG involves the use of β blockers.…”

Lesiones vasculares gástricas en la cirrosis: gastropatía y ectasia vascular antral

“…El sucralfato o los inhibidores de la bomba de protones tampoco se han demostrado efectivos 49,59 . El losartán es un fármaco que, en modelos experimentales con ratas, disminuye la presión portal a través de la inhibición del receptor de la angiotensina-ii 60 , y en estudios con humanos parece tener resultados prometedores 61 .…”