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Management of portal hypertensive gastropathy and GAVE in cirrhosis

The latest publication of the Alimentary Pharmacology & Therapeutics evaluates the management of portal hypertensive gastropathy and gastric antral vascular ectasia in cirrhosis.

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Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) are important causes of both acute and chronic gastrointestinal (GI) bleeding in patients with cirrhosis.

Drs Patwardhan and Cardenas from Spain reviewed the current management of Portal hypertensive gastropathy and GAVE.

PubMed was searched for English language articles using the key words ‘GAVE’, ‘gastric antral vascular ectasia’, ‘cirrhosis’, ‘gastrointestinal bleeding’, ‘acute’, ‘chronic’, ‘portal hypertensive gastropathy’, ‘watermelon stomach’, ‘radiofrequency ablation’, ‘band ligation’, ‘thermoablation’ and ‘TIPSS’.

The team noted that GAVE and portal hypertensive gastropathy are both encountered in patients with cirrhosis.

The management of GAVE is predominantly endoscopic
Alimentary Pharmacology & Therapeutics

They can be seen in asymptomatic patients and in those with either acute or chronic gastrointestinal bleeding.

Portal hypertensive gastropathy, by definition, requires the presence of portal hypertension, with or without cirrhosis, whereas GAVE requires neither cirrhosis nor portal hypertension.

The team report that they can often be diagnosed on endoscopic appearance alone, but may require biopsy in certain cases.

The researchers observed that the treatment of portal hypertensive gastropathy is aimed at reducing hepatic venous pressure gradients, most often by pharmacologic means, but may require shunt procedures in severe cases.

The team noted that the management of GAVE on the other hand is predominantly endoscopic, focusing on various ablative techniques.

Dr Cardenas and colleague comment, "Gastric antral vascular ectasia and portal hypertensive gastropathy are distinct entities and are both encountered in cirrhotic patients."

"Management of portal hypertensive gastropathy is centred on reduction in portal pressures, whereas treatment of gastric antral vascular ectasia is predominantly endoscopic."

Aliment Pharmacol Ther 2014: 40(4): 354–362
29 July 2014

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