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The natural history of portal hypertensive gastropathy: influence of variceal eradication.
Am J Gastroenterol. 2000 Oct; 95(10):2888-93.AJ

Abstract

OBJECTIVE

The natural history and likelihood of bleeding from portal hypertensive gastropathy (PHG) present in patients with portal hypertension before endoscopic variceal obliteration may differ from that in patients who develop PHG during or after variceal eradication.

METHODS

A total of 967 variceal bleeders who had achieved variceal eradication by endoscopic sclerotherapy in the recent past were prospectively studied. In all, 88 (9.1%) patients (cirrhosis in 54, noncirrhotic portal fibrosis in 18, and extrahepatic portal vein obstruction in 16) had distinct mucosal lesions. PHG alone was present in 78, PHG with gastric antral vascular ectasia (GAVE) in eight, and GAVE alone in two patients. PHG was graded as mild or severe and according to whether present before (group A) or after endoscopic intervention (group B). Patients underwent regular endoscopy at follow-up to see if the PHG was transitory (disappearing within 3 months), persistent (no change), or progressive. Bleeding from PHG lesions was defined as acute or chronic.

RESULTS

Twenty-two (26%) patients had PHG before (group A) and 64 (74%) developed PHG after variceal eradication (group B). During a mean follow-up of 25.1 +/- 14.2 months, PHG lesions disappeared in group A in only two patients (9%), but in group B in 28 (44%) patients (p < 0.05). PHG lesions more often progressed in the former as compared to the latter (18% vs 9.4%, p = NS). The incidence of bleeding was higher in group A than group B (32% vs 4.7%, p < 0.02). Bleeding from PHG occurred in 10 patients (11.6%); seven of them were from group A, and all had either progressive (n = 3) or persistent (n = 4) lesions.

CONCLUSIONS

PHG developing after variceal eradication is often transitory and less severe. If PHG is pre-existing, endoscopic therapy for varices could worsen the PHG, with a likelihood of bleeding. Such patients may be benefited by concomitant beta-blocker therapy.

Authors+Show Affiliations

Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11051364

Citation

Sarin, S K., et al. "The Natural History of Portal Hypertensive Gastropathy: Influence of Variceal Eradication." The American Journal of Gastroenterology, vol. 95, no. 10, 2000, pp. 2888-93.
Sarin SK, Shahi HM, Jain M, et al. The natural history of portal hypertensive gastropathy: influence of variceal eradication. Am J Gastroenterol. 2000;95(10):2888-93.
Sarin, S. K., Shahi, H. M., Jain, M., Jain, A. K., Issar, S. K., & Murthy, N. S. (2000). The natural history of portal hypertensive gastropathy: influence of variceal eradication. The American Journal of Gastroenterology, 95(10), 2888-93.
Sarin SK, et al. The Natural History of Portal Hypertensive Gastropathy: Influence of Variceal Eradication. Am J Gastroenterol. 2000;95(10):2888-93. PubMed PMID: 11051364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The natural history of portal hypertensive gastropathy: influence of variceal eradication. AU - Sarin,S K, AU - Shahi,H M, AU - Jain,M, AU - Jain,A K, AU - Issar,S K, AU - Murthy,N S, PY - 2000/10/29/pubmed PY - 2001/2/28/medline PY - 2000/10/29/entrez SP - 2888 EP - 93 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 95 IS - 10 N2 - OBJECTIVE: The natural history and likelihood of bleeding from portal hypertensive gastropathy (PHG) present in patients with portal hypertension before endoscopic variceal obliteration may differ from that in patients who develop PHG during or after variceal eradication. METHODS: A total of 967 variceal bleeders who had achieved variceal eradication by endoscopic sclerotherapy in the recent past were prospectively studied. In all, 88 (9.1%) patients (cirrhosis in 54, noncirrhotic portal fibrosis in 18, and extrahepatic portal vein obstruction in 16) had distinct mucosal lesions. PHG alone was present in 78, PHG with gastric antral vascular ectasia (GAVE) in eight, and GAVE alone in two patients. PHG was graded as mild or severe and according to whether present before (group A) or after endoscopic intervention (group B). Patients underwent regular endoscopy at follow-up to see if the PHG was transitory (disappearing within 3 months), persistent (no change), or progressive. Bleeding from PHG lesions was defined as acute or chronic. RESULTS: Twenty-two (26%) patients had PHG before (group A) and 64 (74%) developed PHG after variceal eradication (group B). During a mean follow-up of 25.1 +/- 14.2 months, PHG lesions disappeared in group A in only two patients (9%), but in group B in 28 (44%) patients (p < 0.05). PHG lesions more often progressed in the former as compared to the latter (18% vs 9.4%, p = NS). The incidence of bleeding was higher in group A than group B (32% vs 4.7%, p < 0.02). Bleeding from PHG occurred in 10 patients (11.6%); seven of them were from group A, and all had either progressive (n = 3) or persistent (n = 4) lesions. CONCLUSIONS: PHG developing after variceal eradication is often transitory and less severe. If PHG is pre-existing, endoscopic therapy for varices could worsen the PHG, with a likelihood of bleeding. Such patients may be benefited by concomitant beta-blocker therapy. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11051364/The_natural_history_of_portal_hypertensive_gastropathy:_influence_of_variceal_eradication_ L2 - https://doi.org/10.1111/j.1572-0241.2000.03200.x DB - PRIME DP - Unbound Medicine ER -