Portal Hypertensive Gastropathy As a Prognostic Index in Patients with Liver Cirrhosis

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2016 Aug 14

PMID 27519178

Citations 6

Authors

Chang Seok Bang

Hyo Sun Kim

Ki Tae Suk

Sung Eun Kim

Ji Won Park

Seung Ha Park

Hyoung Su Kim

Myoung Kuk Jang

Sang Hoon Park

Myung Seok Lee

Choong Kee Park

Dong Joon Kim

Affiliations

Soon will be listed here.

Abstract

Background: Portal hypertensive gastropathy (PHG) is a frequently overlooked complication of liver cirrhosis (LC). The clinical implications of PHG as a prognostic factor of LC or a predictive factor for the development of hepatocellular carcinoma (HCC) have not been established. The aim of this study was to assess the clinical significance of PHG in patients with LC.

Methods: Patients with LC were prospectively enrolled and followed in a single tertiary hospital in the Republic of Korea. Baseline hepatic vein pressure gradient (HVPG) was measured, and esophagogastroduodenoscopy (EGD) was performed. The associations of PHG with HVPG, survival and the development of HCC were evaluated.

Results: A total of 587 patients were enrolled. The mortality rate was 20.3 % (n = 119), and HCC developed in 9.2 % (n = 54) during the follow-up period (32.6 ± 27.8 months). The grade of PHG was well correlated with HVPG (no PGH: median 9.2 [IQR: 7.2-16.7], mild PHG: 14.6 [10.1-19.3], and severe PHG: 17.3 [12.3-21.5], P < 0.001), as well as with Child-Pugh class, MELD score or survival. However, it was not associated with the development of HCC. The grade of PHG (HR 3.29, 95 % CI: 1.12-9.63, severe vs. no PHG) and Child-Pugh class (HR 3.53, 95 % CI: 1.79-6.97, Child C vs A) showed significant associations with mortality.

Conclusion: PHG was well correlated with portal hypertension and could be used as a prognostic factor for LC but not for the prediction of HCC.

Citing Articles

A Nomogram for Predicting Portal Hypertensive Gastropathy in Patients With Liver Cirrhosis: A Retrospective Analysis.

Wang W, Mu Z, Zhu G, Wang T, Lai S, Guo Y Front Med (Lausanne). 2022; 9:834159.

PMID: 35252265 PMC: 8894675. DOI: 10.3389/fmed.2022.834159.

Quantification of gastric mucosal microcirculation as a surrogate marker of portal hypertension by spatially resolved subdiffuse reflectance spectroscopy in diagnosis of cirrhosis: a proof-of-concept study.

Mohanty A, Eshein A, Kamineni P, Avissar U, Bliss C, Long M Gastrointest Endosc. 2021; 94(1):60-67.e1.

PMID: 33385462 PMC: 8546777. DOI: 10.1016/j.gie.2020.12.037.

Portal hypertensive gastropathy is associated with iron deficiency anemia.

Simbrunner B, Beer A, Woran K, Schmitz F, Primas C, Wewalka M Wien Klin Wochenschr. 2020; 132(1-2):1-11.

PMID: 31912289 PMC: 6978296. DOI: 10.1007/s00508-019-01593-w.

Prevalence of Portal Hypertensive Gastropathy in Chronic Liver Disease and Correlation with the Severity of Liver disease.

Tiwari P, Kc S, Sharma D, Paudel M, Mandal A Cureus. 2019; 11(8):e5454.

PMID: 31641555 PMC: 6802813. DOI: 10.7759/cureus.5454.

Clinically Evident Portal Hypertension: An Operational Research Definition for Future Investigations in the Pediatric Population.

Bass L, Shneider B, Henn L, Goodrich N, Magee J J Pediatr Gastroenterol Nutr. 2019; 68(6):763-767.

PMID: 30908382 PMC: 6534459. DOI: 10.1097/MPG.0000000000002333.

References

Kamath P, Lacerda M, Ahlquist D, McKusick M, Andrews J, Nagorney D . Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology. 2000; 118(5):905-11. DOI: 10.1016/s0016-5085(00)70176-4. View

Garcia-Tsao G, Friedman S, Iredale J, Pinzani M . Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010; 51(4):1445-9. PMC: 2882065. DOI: 10.1002/hep.23478. View

Pinzone M, Zanghi A, Rapisarda L, DAgata V, Benanti F, Sparta D . Cirrhotic patients are still at risk of developing hepatocellular carcinoma despite Interferon-induced sustained virological response. Eur Rev Med Pharmacol Sci. 2014; 18(2 Suppl):11-5. View

Abbasi A, Bhutto A, Butt N, Munir S, Dhillo A . Frequency of portal hypertensive gastropathy and its relationship with biochemical, haematological and endoscopic features in cirrhosis. J Coll Physicians Surg Pak. 2011; 21(12):723-6. DOI: 12.2011/JCPSP.723726. View

Ohta M, Hashizume M, Higashi H, Ueno K, Tomikawa M, Kishihara F . Portal and gastric mucosal hemodynamics in cirrhotic patients with portal-hypertensive gastropathy. Hepatology. 1994; 20(6):1432-6. DOI: 10.1002/hep.1840200609. View

Giofre M, Meduri G, Pallio S, Calandra S, Magnano A, Niceforo D . Gastric permeability to sucrose is increased in portal hypertensive gastropathy. Eur J Gastroenterol Hepatol. 2000; 12(5):529-33. DOI: 10.1097/00042737-200012050-00009. View

Kim M, Baik S, Yea C, Lee I, Kim H, Park K . Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis. Eur J Gastroenterol Hepatol. 2009; 21(11):1241-6. DOI: 10.1097/MEG.0b013e32832a21c1. View

Westerhoff M, Tretiakova M, Hovan L, Miller J, Noffsinger A, Hart J . CD61, CD31, and CD34 improve diagnostic accuracy in gastric antral vascular ectasia and portal hypertensive gastropathy: An immunohistochemical and digital morphometric study. Am J Surg Pathol. 2010; 34(4):494-501. DOI: 10.1097/PAS.0b013e3181d38f0a. View

De Palma G, Rega M, Masone S, Persico F, Siciliano S, Patrone F . Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc. 2005; 62(4):529-34. DOI: 10.1016/s0016-5107(05)01588-9. View

10.

Ripoll C, Garcia-Tsao G . Management of gastropathy and gastric vascular ectasia in portal hypertension. Clin Liver Dis. 2010; 14(2):281-95. PMC: 2916868. DOI: 10.1016/j.cld.2010.03.013. View

11.

Lan C, Sun X, Dong L, Huang B, Yuan S, Wu K . The role of endotoxin in the pathogenesis of gastric mucosal damage in cirrhotic rats with portal hypertensive gastropathy. Asian Pac J Trop Med. 2011; 4(3):212-4. DOI: 10.1016/S1995-7645(11)60071-0. View

12.

de Franchis R . Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 2000; 33(5):846-52. DOI: 10.1016/s0168-8278(00)80320-7. View

13.

Herbst D, Reddy K . Risk factors for hepatocellular carcinoma. Clin Liver Dis (Hoboken). 2019; 1(6):180-182. PMC: 6499296. DOI: 10.1002/cld.111. View

14.

Perini R, Camara P, Ferraz J . Pathogenesis of portal hypertensive gastropathy: translating basic research into clinical practice. Nat Clin Pract Gastroenterol Hepatol. 2009; 6(3):150-8. DOI: 10.1038/ncpgasthep1356. View

15.

Curvelo L, Brabosa W, Rhor R, Lanzoni V, Parise E, Ferrari A . Underlying mechanism of portal hypertensive gastropathy in cirrhosis: a hemodynamic and morphological approach. J Gastroenterol Hepatol. 2009; 24(9):1541-6. DOI: 10.1111/j.1440-1746.2009.05871.x. View

16.

Schepis F, Camma C, Niceforo D, Magnano A, Pallio S, Cinquegrani M . Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?. Hepatology. 2001; 33(2):333-8. DOI: 10.1053/jhep.2001.21410. View

17.

Iwao T, Toyonaga A, Sumino M, Takagi K, OHO K, NISHIZONO M . Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology. 1992; 102(6):2060-5. DOI: 10.1016/0016-5085(92)90332-s. View

18.

Panes J, Bordas J, Pique J, Bosch J, Garcia-Pagan J, Feu F . Increased gastric mucosal perfusion in cirrhotic patients with portal hypertensive gastropathy. Gastroenterology. 1992; 103(6):1875-82. DOI: 10.1016/0016-5085(92)91447-c. View

19.

Quintero E, Pique J, Bombi J, Bordas J, Sentis J, Elena M . Gastric mucosal vascular ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology. 1987; 93(5):1054-61. DOI: 10.1016/0016-5085(87)90569-5. View

20.

de Macedo G, Ferreira F, Ribeiro M, Szutan L, Assef M, Rossini L . Reliability in endoscopic diagnosis of portal hypertensive gastropathy. World J Gastrointest Endosc. 2013; 5(7):323-31. PMC: 3711063. DOI: 10.4253/wjge.v5.i7.323. View