Copyright
©The Author(s) 2016.
World J Hepatol. Feb 8, 2016; 8(4): 231-262
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.231
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.231
Table 9 Differences between portal hypertensive gastropathy and gastric antral vascular ectasia
Parameter | Portal hypertensive gastropathy | Gastric antral vascular ectasia | Ref. |
Associated conditions | Conditions associated with portal hypertension: cirrhotic or non-cirrhotic portal hypertension | Cirrhosis, autoimmune disorders, and connective tissue diseases (scleroderma, pernicious anemia, hypothyroidism) | [72] |
Association with portal hypertension | Strong association | Only 30% of cases | [191,192] |
Sex | Mildly more common in males (alcoholic cirrhosis more common in males than females) | Much more common in females (80%) | [193,194] |
Age | Can occur at any age in patients with portal hypertension or cirrhosis | Typically elderly (average age > 70 years old) | |
Location | Proximal stomach: Fundus, body | Distal stomach: Antrum | [72,192] |
Diagnosis | Endoscopy (endoscopic biopsy sometimes useful). Radiologic imaging usually not helpful | Endoscopy (endoscopic biopsy sometimes useful) | [72,195] |
Appearance at endoscopy | Mosaic/snakeskin mucosa with red or brown spots | Tortuous columns of ectatic vessels in "watermelon" or diffuse pattern; erythematous or hemorrhagic | [191] |
Histology | Ectatic capillaries, mildly dilated mucosal and submucosal veins; no vascular inflammation, no vascular thrombi | Marked dilation of capillaries and venules in gastric mucosa and submucosa with areas of intimal thickening, fibrin thrombi, fibromuscular hyperplasia and spindle cell proliferation | [72,191,196,197] |
Clinical presentation/ complications | Gastrointestinal bleeding: Usually chronic, but sometimes acute | Almost exclusively chronic gastrointestinal bleeding with guaiac positive stools | [37,193] |
Primary prophylaxis | Not indicated | Not indicated (unless associated with large varices) | [198] |
Medical therapy | Non-selective β-adrenergic receptor antagonists (propranolol), octreotide (for acute bleeding) | No benefit of β-adrenergic receptor antagonists | [103,106,198-201] |
Oral contraceptive pills to temporarily control bleeding | |||
Questionable benefit of octreotide | |||
Endoscopic therapy | Occasionally helpful (for focal bleeding) | Very helpful at reducing risk of bleeding: Argon plasma coagulation; EBL; Radiofrequency ablation; YAG laser therapy | [202-207] |
Argon plasma coagulation | |||
Local hemostasis with hemospray | |||
TIPS | Significantly reduces severity and risk of bleeding by reducing portal hypertension. Option for very severe bleeding from PHG or for moderate PHG in patients with variceal bleeding | Not recommended. Does not affect severity of GAVE or risk of bleeding | [75,77] |
Liver transplantation | Resolves. Ultimate therapy mostly reserved for patients with end-stage liver disease | Improves or resolves with liver transplantation | [75,200,208-210] |
Other surgery | Usually resolves with shunt surgery that lowers portal pressure. Partial gastrectomy not recommended | Limited surgical resection (partial gastrectomy) recommended for refractory cases. Shunt surgery not recommended | [75,200,211-213] |
Prognosis from bleeding | Bleeding rarely severe and very rarely fatal | Bleeding occasionally severe | [34,71,72] |
- Citation: Gjeorgjievski M, Cappell MS. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy. World J Hepatol 2016; 8(4): 231-262
- URL: https://www.wjgnet.com/1948-5182/full/v8/i4/231.htm
- DOI: https://dx.doi.org/10.4254/wjh.v8.i4.231