portal hypertensive gastropathy
Monday 12 March 2012
Portal hypertensive gastropathy (PHG) is a vasculopathy involving the gastric microvasculature in both adults and children with portal hypertension.
Mild PHG is highly prevalent in cirrhotics,while severe changes are only seen in 10% to 25% of these patients.
The disorder presents with bleeding in severe cases.
A hallmark of the condition is mucosal and submucosal capillary and venous ectasia that insevere PHG imparts a typical mosaic appearance.
The mucosa appears “beefy”red with multiple petechial hemorrhages, red spots, ulcers, and erosions.
Patients exhibit increased mucosal blood ﬂow.
Vascular congestion, ratherthan erosions, damages the mucosa.
Histologically, mucosal capillary and venous ectasia and submucosal venous dilation are present.
The submucosal vessels may appear thickened and abnormal.
These changes occur in the absence oferosions oinﬂammation.
Propranolol and various jugular intra-hepatic portosystemic shunts are used to treat PHG.
The differential diagnosis includes gastric vascular ectasia, another condition that is common in cirrhotic patients.
gastric vascular anomalies