Korean J Gastroenterol.  2010 Sep;56(3):186-191. 10.4166/kjg.2010.56.3.186.

Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia

• Choe WH

• KMID: 948780
• DOI: http://doi.org/10.4166/kjg.2010.56.3.186

Abstract

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.

Keyword

Gastric antral vascular ectasia; Liver cirrhosis; Hypertension, Portal; Portal hypertensive gastropathy

MeSH Terms

Esophageal and Gastric Varices/*diagnosis/etiology/therapy
Gastric Antral Vascular Ectasia/*diagnosis/etiology/therapy
Gastric Mucosa/metabolism/pathology
Humans
Hypertension, Portal/*complications
Portasystemic Shunt, Transjugular Intrahepatic
Vasodilator Agents/therapeutic use

Figure

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  Fig. 1. Representative photos of mild portal hypertensive gastropathy (A) and severe portal hypertensive gastropathy (B). These images were adopted from reference 5.

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  Fig. 2. Relationships between the severity of portal hypertensive gastropathy and hepatic venous pressure gradient. These images were adopted from reference 5. PHG, portal hypertensive gastropathy; HVPG, hepatic venous pressure gradient.

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  Fig. 3. Schematic diagram of how nitration of ERK participates in impaired mucosal healing in portal hypertensive gastric mucosa. ERK 1/2, extracelluar signal regulated protein kinase 1/2; LPO, lipid peroxide; MEK, Mitogen-activated ERK kinase; NO, nitric oxide; ONOO., peroxynitrite; Thr 183, phosphorylation (activation) at threonine 183 residue; Tyr 185, phosphorylation (activation) at tyrosine 185 residue.

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  Fig. 4. Natural history of portal hypertensive gastropathy. PHG, portal hypertensive gastropathy.

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  Fig. 5. Effects of propranolol in patients with portal hypertensive gastropathy.

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  Fig. 6. Representative photos of striped-type gastric antral vascular ectasia (watermelon stomach) (A) and punctate- type gastric antral vascular ectasia (honeycomb pattern) (B).

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