Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 8, 2016; 8(4): 231-262
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.231
Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy
Mihajlo Gjeorgjievski, Mitchell S Cappell
Mihajlo Gjeorgjievski, Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
Mitchell S Cappell, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, United States
Author contributions: Gjeorgjievski M and Cappell MS are equal authors; they contributed equally to conceiving and planning this project, to performing the systematic review, to retrieving and analyzing the data from the literature, to writing the manuscript, and to editing of the final manuscript.
Conflict-of-interest statement: None for all authors. This paper does not discuss any confidential pharmaceutical industry data reviewed by Cappell MS as a consultant for the United States Food and Drug Administration (FDA) Advisory Committee on Gastrointestinal Drugs. Cappell MS is a member of the speaker’s bureau for AstraZeneca. This paper does not discuss any drug manufactured or marketed by AstraZeneca.
Data sharing statement: The paper has no original data or original statistics presented. No additional data are, therefore, available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mitchell S Cappell, MD, PhD, Chief, Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, United States.
Telephone: +1-248-5511227 Fax: +1-248-551758
Received: October 2, 2015
Peer-review started: October 4, 2015
First decision: November 4, 2015
Revised: November 30, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: February 8, 2016
Core Tip

Core tip: Portal hypertensive gastropathy (PHG) is diagnosed by characteristic endoscopic findings of variably erythematous, small, polygonal areas surrounded by a whitish, reticular border in a mosaic pattern in the gastric fundus/body in a patient with portal hypertension of any etiology. The pathophysiology of PHG is inadequately understood. Portal hypertension is a prerequisite to develop PHG. PHG increases in frequency with increasing portal hypertension, liver disease progression, duration of liver disease, presence of esophageal varices, and endoscopic variceal obliteration. Pathogenesis is related to a hyperdynamic circulation induced by portal hypertension. Gastric mucosa in PHG exhibits greater susceptibility to gastrotoxic chemicals and poor wound healing. Acute or chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate and rarely fatal. Endoscopic therapy is rarely useful. Pharmacotherapy for acute bleeding includes octreotide with concomitant proton-pump-inhibitor therapy, or alternatively vasopressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent re-bleeding after acute bleeding or for chronic bleeding. Transjugular-intrahepatic-portosystemic-shunt and liver transplantation is ultimate therapies because they treat the underlying portal hypertension.