Korean J Gastroenterol.  2017 May;69(5):278-282. 10.4166/kjg.2017.69.5.278.

Elevated Gastric Antrum Erosions in Portal Hypertension Patients: Peptic Disease or Mucosal Congestion?

• Cordeiro de Azevedo Conejo F
• Fracassi M
• Assef MS
• Ribeiro MA
• Szutan LA
• Ferreira F

• KMID: 2383385
• DOI: http://doi.org/10.4166/kjg.2017.69.5.278

Abstract

BACKGROUND/AIMS
Portal hypertension (PH) is a syndrome characterized by chronic increase in the pressure gradient between the portal vein and inferior vena cava. Previous studies have suggested an increased frequency of antral elevated erosive gastritis in patients with PH, as well as an etiologic association; however, there has not been any histological evidence of this hypothesis to date. Our aim was to evaluate the histological features found in elevated antral erosions in patients with portal hypertension.
METHODS
Sixty-nine patients were included; 28 with and 41 without PH. All patients underwent endoscopy, and areas with elevated antral erosion were biopsied.
RESULTS
In the PH group, 24 patients had inflammatory infiltration with or without edema and vascular congestion, and 4 patients had no inflammation. In the group without PH, all patients showed inflammatory infiltration of variable intensity. There was no statistical significance between the two groups in the presence of Helicobacter pylori. There as a histological similarity between the two groups, if PH patients without inflammation were excluded; however, more edema and vascular congestion were observed in the PH group (p=0.002).
CONCLUSIONS
The findings show that elevated antral erosions in patients with PH have more evident edema and vascular congestion in addition to lymphocytic infiltration.

Keyword

Hypertension, portal; Gastritis; Gastric antral vascular ectasia; Lymphocytes; Edema

MeSH Terms

Edema
Endoscopy
Estrogens, Conjugated (USP)*
Gastric Antral Vascular Ectasia
Gastritis
Helicobacter pylori
Humans
Hydrogen-Ion Concentration
Hypertension, Portal*
Inflammation
Lymphocytes
Portal Vein
Pyloric Antrum*
Vena Cava, Inferior
Estrogens, Conjugated (USP)

Figure

• 

  Fig. 1 Elevated antral erosions (arrows) in portal hypertensive gastropathy.

• 

  Fig. 2 Biopsies of elevated antral erosions in portal hypertensive gastropathy. (A) Edema and vascular congestion (H&E, ×200). (B) Lymphocytic infiltration (H&E, ×400).

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