Portal hypertensive gastropathy

Portal hypertensive gastropathy is a medical condition characterized by changes in the mucosa of the stomach due to portal hypertension. It is often associated with cirrhosis of the liver and is a common cause of gastrointestinal bleeding.

Etiology

The exact cause of portal hypertensive gastropathy is not fully understood. However, it is believed to be related to increased pressure in the portal vein system, which is often caused by cirrhosis of the liver. Other potential causes include congestive heart failure, hepatic vein thrombosis, and schistosomiasis.

Pathophysiology

Portal hypertensive gastropathy is characterized by changes in the mucosa of the stomach. These changes include erythema, edema, and friability, as well as the presence of vascular ectasia and spider angiomata. The increased pressure in the portal vein system leads to dilation of the submucosal veins, which in turn leads to the characteristic changes in the mucosa.

Clinical Presentation

Patients with portal hypertensive gastropathy may present with a variety of symptoms, including anemia due to chronic gastrointestinal bleeding, melena, hematemesis, and epigastric pain. However, many patients are asymptomatic and the condition is often discovered incidentally during endoscopy.

Diagnosis

The diagnosis of portal hypertensive gastropathy is typically made via endoscopy, which allows for direct visualization of the characteristic changes in the mucosa. Other diagnostic tests may include laboratory tests to assess for anemia and liver function, as well as imaging studies to evaluate for cirrhosis and portal hypertension.

Treatment

The treatment of portal hypertensive gastropathy primarily involves managing the underlying cause of the portal hypertension. This may include treating the cirrhosis or congestive heart failure, or managing the hepatic vein thrombosis or schistosomiasis. In addition, patients may be treated with medications to reduce the pressure in the portal vein system and to manage the gastrointestinal bleeding.

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  Portal hypertensive gastropathy
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  Gastric antral vascular ectasia (before and after)