The Relationship Between Portal Hypertension and Portal Hypertensive Gastropathy

Overview

Journal Scand J Gastroenterol

Publisher Informa Healthcare

Specialty Gastroenterology

Date 2021 Dec 14

PMID 34904513

Citations 1

Authors

Mohamad Kareem Marrache

Halim Bou Daher

Don C Rockey

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Portal hypertensive gastropathy (PHG) most commonly occurs in the setting of increased portal pressure in patients with cirrhosis. Here, we aimed to understand the correlation between hepatic venous pressure gradient (HVPG) and the presence and severity of PHG in patients with cirrhosis.

Methods: We examined patients with cirrhosis who underwent HVPG measurement at the Medical University of South Carolina between 2014 and 2020. Extensive demographic, clinical, laboratory, procedural (including precise grading of PHG severity using standard definitions), and outcome data were abstracted at the time of HVPG measurement.

Results: Three hundred and ten patients with HVPG measurements and cirrhosis were identified. Seventy-three patients having endoscopy within 6 months of HVPG measurement were included (mean age 54 ± 11, 44% female). The most common causes of cirrhosis were alcohol (41%) and non-alcoholic steatohepatitis (32%). The average HVPG was 15 mmHg (±6) and 62 patients had clinically significant portal hypertension (CSPH) (HVPG ≥ 10 mmHg). Of the 73 patients with HVPG measured, 45 (62%) had PHG, including 40 (89%) of whom had CSPH. Out of the 45 patients with PHG, 41 and four had mild or severe PHG, respectively. MELD scores were similar in patients with and without PHG [15 ± 9 (SD) and 17 ± 9, respectively; = .37]. HVPG was higher in patients with PHG (17 ± 7 mmHg) than those without PHG (13 ± 4 mmHg) ( = .01) but did not differ between mild and severe PHG.

Conclusion: A weak correlation exists between HVPG level and the presence of PHG.

Citing Articles

Risk factors for portal hypertensive gastropathy.

Wu R, Liu K, Shi C, Tian H, Wang N BMC Gastroenterol. 2022; 22(1):436.

PMID: 36241992 PMC: 9563123. DOI: 10.1186/s12876-022-02468-7.

References

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

El-Rifai N, Mention K, Guimber D, Michaud L, Boman F, Turck D . Gastropathy and gastritis in children with portal hypertension. J Pediatr Gastroenterol Nutr. 2007; 45(1):137-40. DOI: 10.1097/MPG.0b013e318049cbe2. View

Iwao T, Toyonaga A, OHO K, Sakai T, Tayama C, Masumoto H . Portal-hypertensive gastropathy develops less in patients with cirrhosis and fundal varices. J Hepatol. 1997; 26(6):1235-41. DOI: 10.1016/s0168-8278(97)80457-6. View

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

Gupta R, Saraswat V, Kumar M, Naik S, Pandey R . Frequency and factors influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension. J Gastroenterol Hepatol. 1996; 11(8):728-33. DOI: 10.1111/j.1440-1746.1996.tb00322.x. 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

Lin W, Lee F, Lin H, Tsai Y, Lee S, Lai K . Snake skin pattern gastropathy in cirrhotic patients. J Gastroenterol Hepatol. 1991; 6(2):145-9. DOI: 10.1111/j.1440-1746.1991.tb01455.x. View

Lopez-Talavera J, Merrill W, Groszmann R . Tumor necrosis factor alpha: a major contributor to the hyperdynamic circulation in prehepatic portal-hypertensive rats. Gastroenterology. 1995; 108(3):761-7. DOI: 10.1016/0016-5085(95)90449-2. View

Albillos A, Colombato L, Enriquez R, Ng O, Sikuler E, Groszmann R . Sequence of morphological and hemodynamic changes of gastric microvessels in portal hypertension. Gastroenterology. 1992; 102(6):2066-70. DOI: 10.1016/0016-5085(92)90333-t. View

10.

Fontana R, Sanyal A, Mehta S, Doherty M, Neuschwander-Tetri B, Everson G . Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial. Am J Gastroenterol. 2006; 101(5):983-92. DOI: 10.1111/j.1572-0241.2006.00461.x. View

11.

Migoh S, Hashizume M, Tsugawa K, Tanoue K, Sugimachi K . Role of endothelin-1 in congestive gastropathy in portal hypertensive rats. J Gastroenterol Hepatol. 2000; 15(2):142-7. DOI: 10.1046/j.1440-1746.2000.02061.x. View

12.

Spina G, Arcidiacono R, Bosch J, Pagliaro L, Burroughs A, Santambrogio R . Gastric endoscopic features in portal hypertension: final report of a consensus conference, Milan, Italy, September 19, 1992. J Hepatol. 1994; 21(3):461-7. DOI: 10.1016/s0168-8278(05)80329-0. View

13.

Urrunaga N, Rockey D . Portal hypertensive gastropathy and colopathy. Clin Liver Dis. 2014; 18(2):389-406. PMC: 4528620. DOI: 10.1016/j.cld.2014.01.008. View

14.

Kaviani A, Ohta M, Itani R, Sander F, Tarnawski A, Sarfeh I . Tumor necrosis factor-alpha regulates inducible nitric oxide synthase gene expression in the portal hypertensive gastric mucosa of the rat. J Gastrointest Surg. 1997; 1(4):371-6. DOI: 10.1016/s1091-255x(97)80059-5. View

15.

Moore K, Wong F, Gines P, Bernardi M, Ochs A, Salerno F . The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003; 38(1):258-66. DOI: 10.1053/jhep.2003.50315. View

16.

Sarin S, Sreenivas D, Lahoti D, Saraya A . Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology. 1992; 102(3):994-9. DOI: 10.1016/0016-5085(92)90188-5. View

17.

Taranto D, Suozzo R, Romano M, di Sapio M, Caporaso N, Del Vecchio Blanco C . Gastric endoscopic features in patients with liver cirrhosis: correlation with esophageal varices, intra-variceal pressure, and liver dysfunction. Digestion. 1994; 55(2):115-20. DOI: 10.1159/000201135. View

18.

Kinjo N, Kawanaka H, Akahoshi T, Yamaguchi S, Yoshida D, Anegawa G . Significance of ERK nitration in portal hypertensive gastropathy and its therapeutic implications. Am J Physiol Gastrointest Liver Physiol. 2008; 295(5):G1016-24. DOI: 10.1152/ajpgi.90329.2008. View

19.

. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010; 53(3):397-417. DOI: 10.1016/j.jhep.2010.05.004. View

20.

Groszmann R, Wongcharatrawee S . The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004; 39(2):280-2. DOI: 10.1002/hep.20062. View