PORTAL HYPERTENSIVE GASTROPATHY: A COMPREHENSIVE REVIEW

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Shabir Shiekh ◽  
Showkat Kadla ◽  
Bilal Khan ◽  
Nisar Shah
Keyword(s):  
Gastrointestinal Bleeding ◽  
Beta Blockers ◽  
Secondary Prophylaxis ◽  
Deficiency Anemia ◽  
Portal Hypertensive Gastropathy ◽  
Shunt Surgery ◽  
Comprehensive Review ◽  
Mucosal Changes ◽  
Gi Bleed ◽  
Gastric Mucosal Changes

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

Regional Survey on the Management of Oesophageal Variceal Haemorrhage

1995 ◽  
Vol 40 (5) ◽  
pp. 149-150 ◽  
Author(s):  
A.J. Stanley ◽  
J.F. Dillon ◽  
P.C. Hayes
Keyword(s):  
Beta Blockers ◽  
Secondary Prophylaxis ◽  
Shunt Surgery ◽  
Variceal Haemorrhage ◽  
Regional Survey ◽  
Band Ligation ◽  
North East ◽  
Portosystemic Shunts

A questionnaire was sent to 116 consultant gastroenterologists in Scotland and North-East England to assess their management of oesophageal variceal haemorrhage. Most respondents (58%) dealt with <10 variceal bleeds per year. Sclerotherapy, tamponade, vasoconstrictor therapy and oesophageal transection were available to 87.5–97.5% clinicians, compared with trans-jugular intrahepatic portosystemic shunts (T1PSS) (39.5%) and band ligation (27%). To arrest bleeding, sclerotherapy, tamponade, octreotide/somatostatin and vasopressin/ glypressin were used by 75.5%, 44.5%, 37% and 32% respectively (many used >1 treatment) and if bleeding continued, transection, TIPSS and shunt surgery were considered by 44.5%, 27% and 6%. Sclerotherapy was used for primary and secondary prophylaxis by 11% and 75.5%, and beta-blockers by 17.5% and 49.5% respectively. A wide variation in the management of variceal haemorrhage therefore exists. Most clinicians do not attempt to prevent primary variceal bleeds, with only a minority using beta-blockers but a significant number using sclerotherapy in this situation.

scholarly journals Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

2017 ◽  
Vol 54 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Júlio Rocha PIMENTA ◽  
Alexandre Rodrigues FERREIRA ◽  
Eleonora Druve Tavares FAGUNDES ◽  
Paulo Fernando Souto BITTENCOURT ◽  
Alice Mendes MOURA ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Children And Adolescents ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Secondary Prophylaxis ◽  
Gastric Fundus ◽  
Portal Hypertensive Gastropathy ◽  
Band Ligation ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND Bleeding of esophageal varices is the main cause of morbidity and mortality in children and adults with portal hypertension and there are few studies involving secondary prophylaxis in children and adolescents. OBJECTIVE To evaluate the efficacy of endoscopic secondary prophylaxis in prevention of upper gastrointestinal bleeding in children and adolescents with esophageal varices. METHODS This is a prospective analysis of 85 patients less than 18 years of age with or without cirrhosis, with portal hypertension. Participants underwent endoscopic secondary prophylaxis with sclerotherapy or band ligation. Eradication of varices, incidence of rebleeding, number of endoscopic sessions required for eradication, incidence of developing gastric fundus varices and portal hypertensive gastropathy were evaluated. RESULTS Band ligation was performed in 34 (40%) patients and sclerotherapy in 51 (60%) patients. Esophageal varices were eradicated in 81.2%, after a median of four endoscopic sessions. Varices relapsed in 38 (55.1%) patients. Thirty-six (42.3%) patients experienced rebleeding, and it was more prevalent in the group that received sclerotherapy. Gastric varices and portal hypertensive gastropathy developed in 38.7% and 57.9% of patients, respectively. Patients undergoing band ligation showed lower rebleeding rates (26.5% vs 52.9%) and fewer sessions required for eradication of esophageal varices (3.5 vs 5). CONCLUSION Secondary prophylaxis was effective in eradicating esophageal varices and controlling new upper gastrointestinal bleeding episodes due to the rupture of esophageal varices. Band ligation seems that resulted in lower rebleeding rates and fewer sessions required to eradicate varices than did sclerotherapy.

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

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.

Obscure gastrointestinal bleeding and iron-deficiency anemia—Where does capsule endoscopy fit?

2015 ◽  
Vol 17 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Emanuele Rondonotti ◽  
Anastasios Koulaouzidis ◽  
Paggi Silvia ◽  
Radaelli Franco ◽  
Marco Pennazio
Keyword(s):  
Iron Deficiency ◽  
Gastrointestinal Bleeding ◽  
Iron Deficiency Anemia ◽  
Capsule Endoscopy ◽  
Obscure Gastrointestinal Bleeding ◽  
Deficiency Anemia

Oral mucosal changes in iron deficiency anemia in a Sri Lankan female population

1983 ◽  
Vol 55 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Ajith W. Ranasinghe ◽  
K.A.A.S. Warnakulasuriya ◽  
G.E. Tennekoon ◽  
B. Seneviratna
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Deficiency Anemia ◽  
Sri Lankan ◽  
Female Population ◽  
Mucosal Changes

Gastric mucosal changes of tuberculosis

1942 ◽  
Vol 9 (12) ◽  
pp. 407-411 ◽  
Author(s):  
Donovan C. Browne ◽  
Gordon Mchardy ◽  
Carl Wilen
Keyword(s):  
Mucosal Changes ◽  
Gastric Mucosal Changes

scholarly journals Diagnosis and management of extrahepatic oesophageal variceal bleed in children in a low resourced setting

2020 ◽  
Vol 54 (4) ◽  
pp. 274-278
Author(s):  
Taiba J. Afaa ◽  
Kokou H. Amegan-Aho ◽  
Elikem Richardson ◽  
Bamenla Goka
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Upper Gastrointestinal Bleeding ◽  
Liver Function Tests ◽  
Tertiary Hospital ◽  
Secondary Prophylaxis ◽  
Resource Constraint ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal

Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension (PH) in children. Portal vein thrombosis (PVT) is the most common cause accounting for up to 75% of cases in developing countries. Upper gastrointestinal bleeding is the most dreaded and commonest presentation of portal hypertension. Successful treatment of paediatric PH, though challenging is performed in resource constraint countries. Cases: Five children presented over three years to a tertiary hospital in Ghana, with massive upper gastrointestinal bleeding. They had anaemia, thrombocytopaenia and four had splenomegaly. Liver function tests, INR, haemoglobin electrophoresis as well as HIV serology, hepatitis B and C screening were all normal. Abdominal doppler ultrasound scan confirmed portal vein thromboses. They were resuscitated and managed with octreotide, propranolol, antibiotics and sclerotherapy or oesophageal variceal banding in the acute setting and long term secondary prophylaxis with propranolol. Subsequently, an algorithm was developed to assist with the management of bleeding from oesophageal varices and the diagnosis of EHPVO. Conclusion: Portal hypertension due to EHPVO is an important cause of upper gastrointestinal (GI) bleeding in children. This can be successfully managed even in a resource constraint setting once the appropriate measures are taken.

Upper GI Bleed, Etiology, Role of Endoscopy in Rural Population of Punjab

2010 ◽  
Vol 1 (3) ◽  
pp. 55-68 ◽  
Author(s):  
Ravinder Singh Malhotra ◽  
K. S. Ded ◽  
Arun Gupta ◽  
Darpan Bansal ◽  
Harneet Singh
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Common Cause ◽  
Endoscopic Techniques ◽  
Gi Bleed ◽  
Upper Gastrointestinal ◽  
Common Variable ◽  
Important Progress

Haematemesis and malena are the two most important symptoms of upper gastrointestinal bleeding . The most common cause of upper gastrointestinal bleeding is due to a peptic ulcer. In this paper, the authors research the cause of bleeding. Contrary to previous studies, results favor esophageal varices, e.g., alcoholism or cirrhosis liver post necrotic, as the most common cause of bleeding rather than a peptic ulcer. The authors’ study is based on an observational retrospective protocol with records of 50 consecutive patients with GI bleeding, attending the emergency room from February 2007 until September 2009. Results show that the treatment of UGI bleeding has made important progress since the introduction of emergency endoscopy and endoscopic techniques for haemostasis. The application of specific protocols significantly decreases rebleeding and the need for surgery, whereas mortality is still high. The data highlight the decreasing trend of peptic ulcer as the sole cause of bleeding, as shown in previous literature, ascertaining that varices are now the most common variable.

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