Portal hypertensive gastropathy (PHG) is a potential cause of bleeding in patients with liver cirrhosis.
Until now, studies on the natural history of PHG have often included patients submitted to endoscopic or pharmacological treatment for portal hypertension.
In this report from researchers in Rome, Italy, a total of 222 cirrhotic patients with mild degree of portal hypertension (i.e., with no or small varices at entry, without previous gastrointestinal bleeding and medical, endoscopic, or angiographic treatment) were followed up with upper endoscopy every 12 months for 47 ± 28 months.
In total, 48 patients presented with PHG (43 mild and 5 severe) upon enrollment.
The presence of esophageal varices was the only independent predictor of the presence of this gastric lesion at multivariate analysis.
The researchers found that the incidence of PHG was 3.0% at 1 yr and 24% at 3 yr, while the progression was 3% at 1 yr and 14% at 3 yr.
|Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe|
|American Journal of Gastroenterology|
In addition, the presence of esophageal varices and the Child-Pugh class B or C at enrollment were predictive of the incidence of PHG.
The researchers found that only Child-Pugh class B or C was correlated with the progression from mild to severe, at multivariate analysis.
On follow-up, the researchers recorded 16 patients as having bled from PHG (9 acutely and 7 chronically) and one had patient died of exsanguination from this lesion.
Dr Merli concluded, "The natural history of portal hypertensive gastropathy is significantly influenced by the severity of liver disease and severity of portal hypertension."
"Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe."