What is Portal Hypertensive Gastropathy (PHG)?
Portal Hypertensive Gastropathy , as the name indicates , is a condition which come about as result of portal hypertension and comprises of change in the abdomen mucosa in masses who are suffering from portal hypertension . cirrhosis of the liver of the liveris the most vulgar campaign of portal hypertension . The change in the stomach mucosa consist of front of blood vessels ectasia at the open and friability of the mucosa . Other symptoms experience by the patients suffer from portal hypertensive gastropathy include bleeding from the stomach , which in uncommon case can expose itself by vomiting line of descent or by appearance of tarry stools / stock in stool ( melaena ) . Portal hypertension can also induce gastric varices and esophageal varix , which are other common cause of upper gastrointestinal bleeding . Upon endoscopic rating , the mucous membrane of the stomach displays a characteristic “ snake - skin ” or mosaic appearance .
discussion of Portal Hypertensive Gastropathy consists of medications and procedural handling .
Signs & Symptoms of Portal Hypertensive Gastropathy
Upon endoscopic evaluation , legal age of the affected role suffering from portal hypertensive gastropathy will exhibit an improve course or a stable row in the gastropathy appearing . Most of the patients suffer from portal hypertensive gastropathy will be asymptomatic . However , subject field reveal that about 1 in 7 patient have portal hypertensive gastropathy will have either acute or chronic symptom of bleeding from gastropathy .
A real number of patients will have symptom which are associated with continuing gastrointestinal bleeding and chronic atomic number 26 deficiency / blood lossanemiaand a modest telephone number of affected role will have symptoms of active GI bleeding . patient bear chronic hemorrhage will suffer from anemia , which make them try medical attention . Chronic bleeding symptom of portal hypertensive gastropathy is a term used to describe a condition where there is step-down of hemoglobin about 2 g / dL within six - calendar month duration without the use of nonsteroidal anti - incitive drugs and without any symptom of discriminating hemorrhage . Symptoms of chronic hemorrhage may also cause iron deficiency anemia and patient can have a positive fecal occult blood examination .
Acute GI hemorrhage is less usual . Diagnosis of penetrative bleeding due to portal hypertensive gastropathy is made upon endoscopy where active bleeding from the lesion of PHG or non - removable clots over the lesions is key out . Diagnosis can also be made if the patient role has portal high blood pressure along with the common stomachal lesions and where there is no other leech beginning watch upon stark assessment of the gastrointestinal tract .
Classification of Portal Hypertensive Gastropathy
Classification of Portal Hypertensive Gastropathy is done on the ground of the severity of the condition . A two - category classification system is the most recommended one , which comprises of :
balmy Portal Hypertensive Gastropathy : Where there is only one alteration in the belly mucosa , that of coming into court of mosaic or snakeskin pattern on it .
grievous Portal Hypertensive Gastropathy : In this , other than the mosaic or snakeskin pattern of the stomach mucous membrane , there is appearance of bulging or flat reddened or smutty - brown berth seen . There also may be active bleeding . The chances of participating bleeding and inveterate anaemia are more in severe PHG .
Diagnosis of Portal Hypertensive Gastropathy
Endoscopy is the common diagnostic trial for portal hypertensive gastropathy where the characteristic show of stomach mucosa , i.e. mosaic - like or serpent peel like appearance of the tummy mucous membrane , can be seen . There may be bearing of crimson spots also . This radiation pattern is often seen throughout the venter . Similar type of approach pattern can be seen in an associated condition have intercourse as watermelon vine stomach or stomachic antral vascular ectasia ( GAVE ) , where the difference is that the ectatic blood vessel are more often seen in the depleted part of the tummy .
Other than endoscopy , magnetized resonance tomography and computed imaging scan also be done for diagnosing of PHG . Upon CT scan , there is enhancement on the inner level of the gastric walls get a line that can argue stomachic over-crowding . MRI scan helps in measuring the diameter of the left gastric , azygos and paraesophageal vena , which is not that conclusive in diagnosing of portal hypertensive gastropathy . Proximal part of the tum which let in the dead body and fundus is the most common location for portal hypertensive gastropathy .
Esophagogastroduodenoscopy and capsule endoscopy can also be done for diagnosis .
Treatment for Portal Hypertensive Gastropathy
discourse for portal hypertensive gastropathy depends on the severity of the condition , patient ’s symptom and the rate of bleeding and include :
medicament to Treat Portal Hypertensive Gastropathy : The first bloodline of treatment is medications , such as genus Beta - blocker , which will help oneself in repress the portal high blood pressure . Propranolol and nadolol , which are non - selective genus Beta blocker , help in decreasing the portal high blood pressure in patients who have esophageal varices . These medicines also serve in annul the portal hypertensive gastropathy that is aggravate from treatment of varices . Other medicine , such as antifibrinolytics , facilitate in cover the bleeding . These medications act by stabilizing the buildup of fibrin at the land site which would hemorrhage . Octreotide can also be used and this medicine have vasoconstriction of the portal organization and helps in reducing the active haemorrhage occurring as a result of portal hypertensive gastropathy .
Procedural Treatment for Portal Hypertensive Gastropathy : intervention of portal hypertensive gastropathy can also be done endoscopically where the inside of the stomach is view via a fiber - optic camera and electrocautery and Argon Plasma Coagulation ( APC ) can be done to halt the haemorrhage from ectatic vessels and along with trying obliteration of the watercraft . However these routine have very limited usage or benefit if the disease is diffuse .
Transjugular Intrahepatic Portosystemic Shunt ( TIPS ) is a procedure for treating portal hypertensive gastropathy which is done under guidance with fluoroscopy . In this procedure , the portal mineral vein is decompressed by shunting a portal venule to a downcast pressure systemic capillary vein .
Cryotherapyis another routine to treat portal hypertensive gastropathy where pressurized carbon dioxide is used to suspend and destroy the tissue in the focal area .
