Portal hypertensive gastropathy with a focus on management

Abstract

Portal hypertensive gastropathy (PHG) is a painless condition of gastric mucosal ectasia and impaired mucosal defense, commonly seen in patients with elevated portal pressures. While it is typically asymptomatic and incidentally discovered on upper endoscopy, acute and chronic bleeding may occur. There are no definitive recommendations for treatment of asymptomatic PHG. Non-selective β-blockers represent the mainstay of therapy for chronic bleeding, while somatostatin and vasopressin and their derivatives may be used in conjunction with supportive measures for acute bleeding. Salvage therapy with transjugular intrahepatic portosystemic shunt or rarely surgical shunt is appropriate when medical management fails. The role of endoscopic therapy for PHG is controversial. Liver transplantation should be considered as a final resort in cases of refractory bleeding due to PHG.

Keywords:

• anemia
• cirrhosis
• congestive gastropathy
• hemorrhage
• portal hypertension
• portal hypertensive gastropathy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Portal hypertensive gastropathy (PHG) is a condition of gastric mucosal ectasia and congestion secondary to portal hypertension.

• PHG is diagnosed endoscopically and patients are often asymptomatic.

• Non-selective β-blockers are the mainstay of prophylaxis against acute and chronic bleeding from PHG.

• Somatostatin and vasopressin derivatives are first-line therapy in the setting of acute bleeding due to PHG.

• Salvage therapy with portal venous decompression via TIPS or surgical shunt is recommended in the management of acute or chronic bleeding due to PHG when medical therapy alone is ineffective.

• Liver transplantation should be considered in patients with refractory bleeding due to PHG not responding to medical or invasive treatment.