Portal hypertensive gastropathy [PHG]: clinical, endoscopoc, and portal haemodynamic assessment

ABSTRACT

Portal hypertensive gastropathy [PHG] is an important complication of both generalized and segmental portal hypertension. The pathophysiology of PHG is still unclear. The aim of this study was to detect the prevalance of PIEIG and factors influencing its development. This study was conducted on 82 patients with portal hypertension. They were divided into 2 groups Group I [non-bleeders] comprised 31 patients, serves as a control group. Group II [bleeders] comprised 51 patients and were subdivided into Group IIa 28 patients who were followed up by endoscopic sclerotherapy [[EST] and Group IIb 23 patients who were followed up by endoscopic band ligation [EBL]. Endoscopy was repeated every 2 weeks till variceal obliteration. All patients were subjected to thorough history taking, clinical examination, laboratory investigations and Doppler ultrasonographic evaluation. In this study the prevalance of PHG was 756%, with no age or sex difference, with increased frequency and severity in patients with child-pugh class B than in patients with class A and C but without statistically significant difference. Again the prevalance of PHG was higher in patients with post-hepatitic cirrhosis than in patients with mixed cirrhosis and patients with pure bilharzial fibrosis but without statistically significant difference. The prevalance and severity of PI-IG was in the presence of esophageal varices, large variceal size, and presence of red signs, while the prevalance and severity was decreased in the presence of gastric varices; however, there were no statistically significant difference. The prevalance and severity of PHG were collectively after endoscopic managment especially with EBL without statistically significant difference. PHG was associated with insignificantly increased portal cross-sectional area, congestion index and portal blood flow. Also, it was associated with decreased portal maximum and mean velocities but the difference was statistically insignificant. We concluded that PHG is quite frequent in patients with cirrhosis, however, the factors studied are not good predictors for its presence