Portal Hypertensive Gastropathy

Portal hypertensive gastropathy (PHG) encompasses the gastric mucosal changes occurring in the setting of portal hypertension,both cirrhotic and non-cirrhotic. Its significance lies in causing acute gastrointestinal bleeding and insidious chronic blood loss presenting as iron deficiency anemia. Diagnosis of PHG is straight-forward, made endoscopically often characterized by a mosaic-like pattern resembling ‘snake-skin’, with or without red spots. Treatment of acute GI bleed is hemodynamic stabilization, vasoconstrictor therapy, antibiotic prophylaxis, non-selective beta-blockers. Endoscopic treatment like APC has a small role. In severe cases, TIPS and shunt surgery can be offered. Secondary prophylaxis of PHG bleeding with non-selective b-blockers is recommended. Keywords: Portal hypertension, Gastrointestinal bleeding, Cirrhosis, Beta-blockers

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The Efficacy of Virtual Chromoendoscopy in the Diagnosis of Portal Hypertensive Gastropathy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.253.chr ◽

2016 ◽

Vol 25 (3) ◽

pp. 289-293

Author(s):

Anda Carmen Achim ◽

Stefan Cristian Vesa ◽

Eugen Dumitru

Keyword(s):

Diagnostic Criteria ◽

White Light ◽

Narrow Band Imaging ◽

Endoscopic Examination ◽

Kappa Statistics ◽

Portal Hypertensive Gastropathy ◽

Mosaic Pattern ◽

White Light Endoscopy ◽

A New Technique ◽

Virtual Chromoendoscopy

Background: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. Aim: To establish the role of i-scan endoscopy in the diagnosis of PHG. Method: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients. The endoscopic diagnostic criteria for PHG followed the Baveno criteria. The interobserver agreement between white light endoscopy and i-scan endoscopy was determined using Cohen’s kappa statistics. Results: Forty-five of the 50 patients met the diagnostic criteria for PHG when examined by i-scan endoscopy and 39 patients were diagnosed with PHG by white light endoscopy. The strength of agreement between the two methods for the diagnosis of PHG was moderate (k=0.565; 95%CI 0.271-0.859; p<0.001). I-scan 1 classified the mosaic pattern better than classic endoscopy; i-scan 2 described better the red spots. Conclusion: I-scan examination increased the diagnostic sensitivity of PHG. The diagnostic criteria (mosaic pattern and red spots) were easier to observe endoscopically using i-scan than in white light.Abbreviations: FICE: Fuji Intelligent chromoendoscopy; GAVE: gastric antral vascular ectasia; NBI: narrow band imaging; PHG: portal hypertensive gastropathy; PHT: portal hypertension; UGIB: upper gastrointestinal bleeding.

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Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy

Case Reports in Gastroenterology ◽

10.1159/000516569 ◽

2021 ◽

pp. 513-518

Author(s):

Samragnyi Madala ◽

Abhishek Polavarapu ◽

Dhineshreddy Gurala ◽

Vivek Gumaste

Keyword(s):

Radiation Therapy ◽

Gastrointestinal Bleeding ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Laser Coagulation ◽

Portal Hypertensive Gastropathy ◽

Gastrointestinal Malignancy ◽

Nonalcoholic Fatty Liver ◽

Increased Risk ◽

Radiation Induced

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.

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Discovery and validation of novel protein markers in mucosa of portal hypertensive gastropathy

BMC Gastroenterology ◽

10.1186/s12876-021-01787-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying Zhu ◽

Wen Xu ◽

Wei Hu ◽

Fang Wang ◽

Yan Zhou ◽

...

Keyword(s):

Portal Hypertension ◽

Gastric Mucosa ◽

Molecular Mechanisms ◽

Early Stage ◽

Trial Registration ◽

Portal Hypertensive Gastropathy ◽

Protein Markers ◽

Decompensated Liver Cirrhosis ◽

Potential Biomarker ◽

Normal Controls

Abstract Background Portal hypertension induced esophageal and gastric variceal bleeding is the main cause of death among patients of decompensated liver cirrhosis. Therefore, a standardized, biomarker-based test, to make an early-stage non-invasive risk assessment of portal hypertension, is highly desirable. However, no fit-for-purpose biomarkers have yet been identified. Methods We conducted a pilot study consisting of 5 portal hypertensive gastropathy (PHG) patients and 5 normal controls, sampling the gastric mucosa of normal controls and PHG patients before and after endoscopic cyanoacrylate injection, using label-free quantitative (LFQ) mass spectrometry, to identify potential biomarker candidates in gastric mucosa from PHG patients and normal controls. Then we further used parallel reaction monitoring (PRM) to verify the abundance of the targeted protein. Results LFQ analyses identified 423 significantly differentially expressed proteins. 17 proteins that significantly elevated in the gastric mucosa of PHG patients were further validated using PRM. Conclusions This is the first application of an LFQ-PRM workflow to identify and validate PHG–specific biomarkers in patient gastric mucosa samples. Our findings lay the foundation for comprehending the molecular mechanisms of PHG pathogenesis, and provide potential applications for useful biomarkers in early diagnosis and treatment. Trial registration and ethics approval: Trial registration was completed (ChiCTR2000029840) on February 25, 2020. Ethics Approvals were completed on July 17, 2017 (NYSZYYEC20180003) and February 15, 2020 (NYSZYYEC20200005).

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