ZHANG Zhiqiang, CHEN Wei, LIU Bo / 临床肝胆病杂志

Objective To investigate the value of spleen volume (SV) in predicting portal hypertensive gastropathy (PHG) and severe PHG in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 168 patients with liver cirrhosis who were admitted to Xiangyang No.1 People's Hospistal Affiliated to Hubei University of Medicine from January 2018 to August 2022, and with the results of gastroscopy as the gold standard, these patients were divided into non-PHG group with 115 patients and PHG group with 53 patients; the PHG group was further divided into mild PHG group with 26 patients and severe PHG group with 27 patients. All patients underwent electronic gastroscopy, abdominal magnetic resonance imaging, and serological examination to obtain related indices and parameters. The group t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to screen out the independent risk factors for PHG and severe PHG, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of related indices or parameters. The area under the Roccurve is compared using Delong test. Results The univariate analysis showed that there were significant differences between the PHG group and the non-PHG group in sex, presence or absence of ascites, hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase, total bilirubin, albumin (Alb), prothrombin time, international normalized ratio, Child-Pugh class, FIB-4 score, King score, Lok score, spleen diameter (SD), SV, platelet count/spleen diameter ratio (PSDR), and platelet count/spleen volume ratio (PSVR) (all P < 0.05), and there were significant differences in Hb, PLT, Alb, SD, SV, PSDR, and PSVR between the mild PHG group and the severe PHG group (all P < 0.05). The multivariate Logistic regression analysis showed that FIB-4 score (odds ratio [ OR ]=1.280, 95% confidence interval [ CI ]: 1.009-1.625, P < 0.05) and SV ( OR =1.007, 95% CI : 1.001-1.013, P < 0.05) were independent risk factors for PHG, and SV ( OR =0.990, 95% CI : 0.980-1.000, P < 0.05) was an independent influencing factor for severe PHG. The ROC curve analysis showed that in predicting PHG, SV had a larger area under the ROC curve (AUC) than FIB-4 score (0.884 vs 0.825, P < 0.05), with a sensitivity of 0.774 and a specificity of 0.870 at the optimal cut-off value of 406.82; in predicting the onset of severe PHG, SV had an AUC of 0.782, with a sensitivity of 0.593 and a specificity of 0.962 at the optimal cut-off value of 714.63. Conclusion SV has a good value in predicting the onset of PHG and severe PHG.

The differences in clinical profiles and imaging features between liver cirrhosis combined with gastroesophageal varices type 2 and isolated gastric varices type 1 / 中华消化内镜杂志

Objective:To investigate the differences in clinical features and imaging findings of cirrhotic patients with fundic varices between gastroesophageal varices type 2 (GOV2) and isolated fundic varices type 1 (IGV1).Methods:Clinical and imaging data of cirrhotic patients with fundic varices treated in Union Hospital, Tonji Medical Colloge, of Huazhong University of Science and Technology from October 2013 to March 2021 were retrospectively analyzed.Results:A total of 210 patients were enrolled, including 139 patients of GOV2 (GOV2 group) and 71 patients of IGV1 (IGV1 group). Blood routine examination results showed that the median value of hemoglobin in GOV2 group was lower than that in IGV1 group(91.00 g/L VS 112.00 g/L, P<0.05). The incidence of portal hypertensive gastropathy (PHG) in GOV2 group was higher than that in IGV1 group [20.14% (28/139) VS 5.63% (4/71), P<0.05]. The incidence of peptic ulcer was lower in GOV2 group than that in IGV1 group [12.23% (17/139) VS 38.03% (27/71), P<0.05]. The median diameter of portal veins in GOV2 group was larger than that in IGV1 group (15.09 mm VS 12.85 mm, P<0.05), and the volume of gastric fundus varices in GOV2 group was smaller than that in IGV1 group (2.14 mL VS 10.00 mL, P<0.05). The proportion of afferent veins in left gastric vein in GOV2 group was higher than that in IGV1 group [98.43% (125/127) VS 77.78% (42/54), P<0.05], and the median diameter of left gastric vein in GOV2 group was larger than that in IGV1 group (5.58 mm VS 4.53 mm, P<0.05). The efferent vessels mainly included gastrorenal shunt and splenorenal shunt. The incidences of gastrorenal shunt [27.56% (35/127) VS 66.67% (36/54)] and splenirenal shunt [12.60% (16/127) VS 25.93% (14/54)] in GOV2 group were lower than those in IGV1 group ( both P<0.05). The incidences of venae parumbilicales vein [38.58% (49/127) VS 12.96% (7/54)] and retroperitoneal collateral shunt [30.71% (39/127) VS 11.11% (6/54)] in GOV2 group were higher than those in IGV1 group (both P<0.05). Conclusion:There is significant heterogeneity in clinical features and imaging findings between cirrhotic patients complicated with GOV2 and IGV1. Recognizing and understanding the differences between the two types of patients is beneficial to taking appropriate clinical measures and improving patient prognosis.

Gastroscopic manifestations of portal hypertensive gastropathy in liver cirrhosis and related factors / 临床肝胆病杂志

ObjectiveTo investigate the gastroscopic manifestations of gastric mucosa in portal hypertensive gastropathy (PHG) and the association of PHG with gastroesophageal varices, ulcers, and liver cirrhosis complications. MethodsA retrospective analysis was performed for the clinical data of 867 patients with liver cirrhosis who were treated in Daping Hospital of Army Medical University from August 2012 to June 2018, and the incidence rates of gastroesophageal varices, PHG, and ulcers were recorded. Meanwhile, the data of spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC) were collected. The chi-square test was used for comparison of categorical data between groups, and a Spearman correlation analysis was also performed. ResultsThe incidence rate of PHG in the patients with liver cirrhosis reached 66.2% (574/867), and gastric mucosa abnormalities in mild PHG were mainly red-spot lesions (68.6%) and snakeskin (56.8%), while diffuse erythema (76.5%) was the main gastric mucosa abnormality in severe PHG. There was a significant difference in the incidence rate of PHG between the patients with different severities of esophageal varices (χ2=304712, P＜0.05), and the severity of PHG increased with the aggravation of esophageal varices (r=0.515, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with different severities of gastric varices (χ2=81.004, P＜0.05), and the severity of PHG was positively correlated with that of gastric varices (r=0.292, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with varices at different locations (χ2=41.361, P＜0.05); the patients with gastric varices alone had the lowest incidence rate of PHG (34.8%) and only had mild PHG, and those with gastroesophageal varices had the highest incidence rate of PHG (85.6%). Among the patients without PHG, 71 (24.2%) were hospitalized due to hematemesis and/or tarry stool, and among the 574 patients with PHG, 316 (55.1%) were hospitalized, and there was a significant difference between the two groups (χ2=74562, P＜0.05). ConclusionPatients with different severities of PHG have different features of gastric mucosa abnormalities. The development and severity of PHG are closely associated with the severity of gastroesophageal varices and are important causes of gastrointestinal bleeding in liver cirrhosis. PHG should be treated and prevented to reduce the risk and complications of gastrointestinal bleeding.

Frequency of Peptic Ulcer Disease Increases with Severity of Cirrhosis of Liver: Experience of Tertiary Level Hospital of Dhaka

Introduction: Cirrhosis of Liver is prevalent in Bangladesh.PUD can coexist with portal hypertension with cirrhosis.Objectives: To identify frequency of peptic ulcer diseaseincreases with severity of cirrhosis of liver.Materials & Methods: Consecutive 96 patients of cirrhosis ofliver had enrolled when found oesophageal varices at ourendoscopy unit during endoscopic evaluations in 4 monthsperiod (August 2017 to November 2017).Results: Total cirrhotic patients enrolled were 114 (M=75,F=39), mean age was 51.80 ± 14.20 yrs (18-86years). HBVwas the leading cause of cirrhosis in 54.18%, HCV 5.22 %,proven NASH were 12.24% and rest were from unknownaetiology. Their average CTP score were 8.6 (12-5), 37.6%associated with portal hypertensive gastropathy. Grade-IIIoesophageal varicose found in 52 patients, whereas grade-II in25 patients. Among this 114 patients 46 (40.62%) revealedpeptic ulcer disease more in the form of gastric ulcer (n=31)than duodenal ulcer (n=10) and both (n=5).Most of the ulcersbelonged to Forrest class III (76.92%).Conclusion: Variceal bleeding and portal hypertensivegastropathy in patients with liver cirrhosis are prevalent causesof bleeding and anaemia. One of the potential causes ofhaematemesis, melaena, and anaemia among these patientsin Bangladesh has been discovered to be peptic ulcer illness.To verify the findings, large, multicenter-controlled trials arerequired.

Correlation Between Helicobacter pylori Infection and Portal Hypertensive Gastropathy: A Meta-analysis / 胃肠病学

Background: Portal hypertensive gastropathy (PHG) is a mucosa damaging disease caused by obstruction of blood drainage, and Helicobacter pylori (Hp) infection may further aggravate the gastric mucosal injury. Aims: To investigate the relationship between PHG and Hp infection. Methods: Literature of Hp infection in liver cirrhosis patients with or without PHG was retrieved from PubMed, Embase, Cochrane Library, ScienceDirect, CBM, CNKI and Wanfang databases. The literature was screened according to the inclusion and exclusion criteria. Meta-analysis was conducted by RevMan 5.3 software. Results: A total of 18 studies involving 2 159 patients with liver cirrhosis were included. Meta-analysis results showed that there was no statistical difference in Hp infection rate in liver cirrhosis patients with and without PHG (OR=1.37, 95% CI: 0.93-2.02, P=0.11). Subgroup analysis show that in ulcer and ulcer-free subgroups, domestic and foreign subgroups, invasive detection methods and non-invasive detection methods subgroups, no significant differences in Hp infection rate were found between liver cirrhosis patients with and without PHG (P>0.05). Conclusions: There is no significant correlation between Hp infection and PHG in patients with liver cirrhosis. The presence of peptic ulcer, different regions and different Hp detection methods have no influence on the result of meta-analysis.

Pathogenesis of portal hypertensive gastropathy in cirrhotic patients and the application of antacids in treatment / 临床肝胆病杂志

Portal hypertensive gastropathy (PHG) has a high incidence rate in cirrhotic patients,leading to a high risk of upper gastrointestinal bleeding.Gastric mucosal injury is the major pathological change of PHG.There are few studies focusing on the clinical application of antacids in the treatment of PHG in cirrhotic patients and there are still controversies over this issue.This article reviews the influencing factors for PHG,the mechanism of gastric mucosal injury,and the application of antacids.It is pointed out that during the treatment of PHG,besides the reduction in portal venous pressure,the application of antacids such as proton pump inhibitors can improve the cure rate of PHG.Prospective randomized control trials with a large sample size are needed to further demonstrate the clinical effect and safety of antacids in the treatment of PHG in cirrhotic patients.

Management of portal hypertensive gastropathy and other bleeding

A major cause of cirrhosis related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Less common causes of gastrointestinal bleeding are peptic ulcers, malignancy, angiodysplasia, etc. Upper gastrointestinal bleeding has been classified according to the presence of a variceal or non-variceal bleeding. Although non-variceal gastrointestinal bleeding is not common in cirrhotic patients, gastroduodenal ulcers may develop as often as non-cirrhotic patients. Ulcers in cirrhotic patients may be more severe and less frequently associated with chronic intake of non-steroidal anti-inflammatory drugs, and may require more frequently endoscopic treatment. Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. Patients with portal hypertension may experience bleeding from the stomach, and pharmacologic or radiologic interventional procedure may be useful in preventing re-bleeding from PHG. Gastric antral vascular ectasia (GAVE) seems to be different disease entity from PHG, and endoscopic ablation can be the first-line treatment.

Expression of heme oxygenase-1 in gastric mucosa of patient with portal hypertensive gastropathy / 中华消化内镜杂志

Objective To explore the expression of heme oxygenase-1 (HO-1) in gastric mucosa of patient with portal hypertensive gastropathy (PHG),and its role in the pathogenesis of PHG.Methods The specimens were obtained from the gastric mucosa of 22 healthy subjects,20 portal hypertension (PHT) without PHG,and 22 PHG patients.Histological changes of the gastric mucosa were detected,and portal venous flow (PVF) was measured.The expression of HO-1 protein in gastric mucosal specimens was assessed by immunohistochemistry and Western blot analysis,respectively.The relationship between HO-1 expression and PHG severity score,HO-1 expression and PVF,PHG severity score and clinical parameters were investigated.Results HO-1 protein expression in gastric mucosa of PHG and PHT was significantly higher than that of the control (P ＜ 0.05),while there was no significant difference in this variable between PHG and PHT (P ＞ 0.05).The positive correlation was detected between HO-1 expression and PHG severity score in PHG patients (r =0.459,P ＜0.05),however,PHG severity score was irrelevant to severity of esophageal varice (r =0.059,P ＞ 0.05) or to Child-Pugh classification (r =-0.001,P ＞ 0.05).Of all the patients with PHT and PHG,no significant correlation was found between HO-1 expression and PVF (r =0.071,P ＞ 0.05).Conclusion HO-1 protein is up-regulated in gastric mucosa of PHG patients,which may contribute to gastric circulation disorder of PHG.

A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease

BACKGROUND/AIMS: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters. METHODS: We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography. RESULTS: The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)xalbumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%. CONCLUSIONS: The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.

Comparación de cápsula endoscópica esofágica y endoscopia digestiva superior para el diagnóstico de varices esofagicas en Maracaibo Venezuela: reporte preliminar / Comparison between esophageal capsule endoscopy and esophagogastroduodenoscopy for the diagnosis of esophageal varices in Maracaibo Venezuela: preliminary report

La cápsula endoscópica (CE) para intestino delgado inició una revolución tecnológica que se extendió a esófago buscando alternativas para la endoscopia digestiva superior (EDS), “gold standard” en estudio de várices esofágicas (VE) pero invasivas y desagradables sin sedación. Antes de EDS con sedación moderada, 9 pacientes cirróticos de consulta de Hepatología, 6 para seguimiento VE (66.6%) y 3 para despistaje (33.4%) ingirieron PillCam™ESO (Given Imaging). Endoscopista entrenado en CE (ciego a hallazgos EDS pero no a historia del paciente) leyó dos veces los resultados. Se evaluó en imágenes CE y EDS: Presencia-tamaño de várices esofágicas, Riesgo de sangrado, Presencia-grado de Gastropatía Portal Hipertensiva (GPH), várices gástricas. Se aplicaron dos cuestionarios de satisfacción: pre y post procedimiento. CE demostró 88,8% de sensibilidad para determinar tamaño y riesgo de sangrado y 66.6% para GPH. Un hallazgo visto solo por CE, incluyó una várice gástrica. 88% de los pacientes manifestó mayor ansiedad-incomodidad con EDS, prefiriendo CE para futuros procedimientos. A pesar de la eficacia, comodidad y utilidad de CE para seleccionar pacientes para EDS, no creemos que pueda sustituir totalmente a EDS por imposibilidad de tratamiento y costo. Los resultados son prometedores, ampliando la muestra tendremos conclusiones más sólidas...

Endoscopic Capsule (EC) for small bowl is a gastrointestinal breakthrough which extended to esophagus searching for alternatives to esophagogastroduodenoscopy (EGD); “gold standard” for esophageal varices (EV) study (but invasive and uncomfortable without sedation). We report our preliminary EC results in Maracaibo. Before EGD with moderated sedation, 9 cirrhotic patients, 6 (55%) for surveillance and 3 for variceal screening, underwent EC PillCam™ESO (Given Imaging). Endoscopist with EC training (blinded to EGD founds but not to patient’s history) read twice the results. EC and EGD images were evaluated for EV size, bleeding risk, portal hypertensive gastropathy (PHG) grade, gastric varices and other founds. Two satisfaction questionnaires were applied (pre and post procedure). EC showed 88.8% sensibility in determining EV size and bleeding risk and 66.6% sensitivity for PHG. A gastric varice was seen only by EC. 88% of the patients were more anxious and uncomfortable with EGD preferring EC for future procedures. Though EC is efficient, comfortable and useful in deciding which patients would benefi t from EGD we don’t think it will totally replace EGD, due to its cost and impossibility for treatment. Results are promising although bigger samples are necessary for solid conclusions...

Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia / 대한소화기학회지

Portal hypertensive gastropathy (PHG) is a term used to define the endoscopic findings of gastric mucosa with a characteristic mosaic-like pattern with or without red spots, and a common finding in patients with portal hypertension. These endoscopic findings correspond to dilated mucosal capillaries without inflammation. The pathogenesis of PHG in not well known, but portal hypertension and some humoral factors seem to be crucial factors for its development. Pharmacological (e.g. propranolol), or interventional radiological (such as transjugular intrahepatic portosystemic shunt) procedures may be useful in preventing re-bleeding from PHG. The classic features of gastric antral vascular ectasia (GAVE) syndrome include red, often haemorrhagic lesions predominantly located in the gastric antrum which can result in significant blood loss. Although the pathogenesis of GAVE is not clearly defined, it seems to be a separate disease entity from PHG, because GAVE generally does not respond to a reduction of portal pressures. Endoscopic ablation (such as argon plasma coagulation) is the first-line treatment of choice. This review will focus on the incidence, clinical importance, etiology, pathophysiology, and treatment of PHG and GAVE syndrome in the setting of portal hypertension.

Expression of inducible nitric oxide synthase in gastric mucosa in the development of portal hypertensive gastropathy in rats and the interventional effect of aminoguanidine / 中华临床营养杂志

@#arkably increases with the development of cirrhosis,which may play an important role in the development of PHG.AG may remarkably ameliorate the degree of PHG，mainly by inhibiting the expression of iNOS in gastric musosa.

The influences of devascularization versus shunt operation on portal hypertensive gastropathy / 中国现代普通外科进展

Objective:To evaluate the effects of devascularization and shunt operation on portal hypertensive gastropathy.Methods:35 patients were divided into 3 groups:(1)devascularization group(14 patients);(2)shunt group(12 patients);(3)control group(9 patients).Gastroscopy was made preoperatively and postoperatively to observe the changes of gastric mucosa,the apoptotic indexes(AI) were measured by TUNEL and the expression of caspase-3 mRNA was detected by reverse transercription polymerese chain reaction(RT-PCR) method.Results:The AI and expression of caspase-3 mRNA of control group were (2.31?0.11)% and 0.51?0.03 respectively,the AI of other groups was significantly higher than the control group(P

Effect of disconnection and portacaval shunt on the expression of caspase-3 in rats with protal hypertensive gastropathy / 中国现代普通外科进展

Objective:To evaluate the effects of disconnection and portacaval shunt on the expression of caspase-3 in rats with portal hypertensive gastropathy.Methods:42 wistar male rats were divided into 4 groups:(1)normal control group;(2)model control group;(3)disconnection group;(4)portacaval shunt group.The expression of caspase-3 mRNA was determined by reverse transcription polymerase chain reaction method.Results:The free portal pressure increased significantly from (1.15?0.13)kPa to (2.68?0.16)kPa after portal vein ligation(P05),while decreased significantly to (1.57?0.23)kPa through portacaval shunt(P

Portal hypertensive gastropathy / 医学研究生学报

Portal hypertensive gastropathy (PHG), a term used to describe the endoscopic appearance of gastric mucosa with a characteristic mosaic-like pattern, is characterized entities that can be associated with gastrointestinal blood loss in patients with portal hypertension. More than 65% of patients with portal hypertension from cirrhosis will develop PHG,however,it could also occur in the setting of non-cirrhotic portal hypertension. In patients with portal hypertension, the incidence of PHG was associated with severity of liver disease and the presence of both oesophageal and gastric varices. The exact etiology of PHG is not clearly defined, the diagnosis of PHG depends on endoscopy and histology, therapy of PHG is directed at lowering portal pressure by ?-blockers or shunt procedures.

Effect of esophageal variceal ligation on portal hypertensive gastropathy / 中国微创外科杂志

Objective To investigate the effect of esophageal variceal ligation (EVL) on portal hypertensive gastropathy (PHG). Methods Gastroscopic examinations were performed both before and after the EVL in 37 cases of PHG. Results The severity of PHG was correlated with the liver functions, and the morbidity of PHG was higher in cases of Child C (100%, 9/9) than in cases of Child A (60%, 12/20) or Child B (80%, 16/20) ( ? 2=18 452,P =0 001). PHG could be exasperated by the application of EVL, but no statistical significance was seen ( ? 2=3 512,P =0 173). On re-examination of gastroscopy 6~12 months later, no relapse or re-bleeding of esophageal varices or gastric mucosa hemorrhage occurred. Conclusions The worse the liver functions, the higher is the incidence of PHG. EVL treatment creates a tendency to aggravating PHG.

The effect of pericardial devascularization with vagustrunk preservation on portal hypertension gastropathy / 中国现代普通外科进展

Objective:To probe the different influence of pericardial devascularization by preserving vagus trunk(VTPPD) and pericardial devascularization (PD) on portal hypertensive gastropathy (PHG).Methods:77 patients with portal hypertension were divided into VTPPD and PD group,the VTPPD group included 36 cases,and PD group included 41 cases.Varices of esophagus and fundus of stomach and PHG were observed by gastroscopy before and 3 weeks after operation in all cases,and compared postoperative incidence of PHG in the 2 groups.Results:In all cases,Varices of esophagus and fundus of stomach disappeared or relieved obviously.The incidence of PHG in VTPPD group before operation was 55.6%(20/36),and that after operation was 69.4%(25/36),the former was not higher statistically(P=0.224);the incidence of PHG in PD group before operation was 61.0%(25/41),and that after operation was 87.8%(36/41),the former was not higher than the latter statistically(P=0.005);and the postoperative incidence of PHG in PD group was higher significantly than that in VTPPD group (P=0.048).There were 8(22.2%,8/36)patients whose degree of PHG aggravated in VTPPD group,and there were 19(46.3%,19/41)patients whose degree of PHG aggravated in PD group,the rate of the former was significantly lower than that of the latter(P=0.027).Conclusion:Comparing with the classic portoazygous devascularization,VTPPD can reduce the incidence and the degree of PHG.

The clinical and endoscopic features of gastric varices / 中华消化内镜杂志

Objective To investigete the clinical and endoscopic featrures of gasrtic varices (GV) in our country. Methods To analyze retroepective study the materials of endoscopically diagnosed GV in 85 patients at our hospital from 1990 to 2000. Result Of 281 patients with varices, GV were detected in 85 (30.2% ) under endoscopy. According to Sarin' a category of GV, GOV - I detected in 63(74. 1 GOV- II 19 (22.4%),IGV- I in2(2.4%) and IGV- II 1 (1. 18%),The common cause of GOV was liver cirrhosis and ICV was segmental portal hypertension without liver disease, No correlation has been observed between the detective rate of GV category and liver function. The rate of portal hypertensive gastropathy (PHC) with GV was higher than that with esophageal varices (EV) only( p

Gastroscopic manifestations of portal hypertensive gastropathy in liver cirrhosis and related factors / 临床肝胆病杂志

ObjectiveTo investigate the gastroscopic manifestations of gastric mucosa in portal hypertensive gastropathy (PHG) and the association of PHG with gastroesophageal varices, ulcers, and liver cirrhosis complications. MethodsA retrospective analysis was performed for the clinical data of 867 patients with liver cirrhosis who were treated in Daping Hospital of Army Medical University from August 2012 to June 2018, and the incidence rates of gastroesophageal varices, PHG, and ulcers were recorded. Meanwhile, the data of spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC) were collected. The chi-square test was used for comparison of categorical data between groups, and a Spearman correlation analysis was also performed. ResultsThe incidence rate of PHG in the patients with liver cirrhosis reached 66.2% (574/867), and gastric mucosa abnormalities in mild PHG were mainly red-spot lesions (68.6%) and snakeskin (56.8%), while diffuse erythema (76.5%) was the main gastric mucosa abnormality in severe PHG. There was a significant difference in the incidence rate of PHG between the patients with different severities of esophageal varices (χ2=304712, P＜0.05), and the severity of PHG increased with the aggravation of esophageal varices (r=0.515, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with different severities of gastric varices (χ2=81.004, P＜0.05), and the severity of PHG was positively correlated with that of gastric varices (r=0.292, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with varices at different locations (χ2=41.361, P＜0.05); the patients with gastric varices alone had the lowest incidence rate of PHG (34.8%) and only had mild PHG, and those with gastroesophageal varices had the highest incidence rate of PHG (85.6%). Among the patients without PHG, 71 (24.2%) were hospitalized due to hematemesis and/or tarry stool, and among the 574 patients with PHG, 316 (55.1%) were hospitalized, and there was a significant difference between the two groups (χ2=74562, P＜0.05). ConclusionPatients with different severities of PHG have different features of gastric mucosa abnormalities. The development and severity of PHG are closely associated with the severity of gastroesophageal varices and are important causes of gastrointestinal bleeding in liver cirrhosis. PHG should be treated and prevented to reduce the risk and complications of gastrointestinal bleeding.