Portal Hypertensive Gastropathy

  • David R. Triger


Although esophageal varices have long been considered to be the major cause of upper gastrointestinal tract hemorrhage in patients with portal hypertension, the literature contains many references to abnormalities of the gastric mucosa in these individuals. Possibly the earliest description of these changes was provided by Preble in 1900 [1] who wrote that “not all cirrhotics who bleed have varices as a source of hemorrhage, simultaneous rupture of many capillaries may cause bleeding in some”. Several series of patients with cirrhosis and upper gastrointestinal hemorrhage have reported erosions and ulcers to account for 30%–40% of bleeds [2–4] although alcohol was initially considered to be responsible for many of the lesions since the patient populations reported were predominantly alcoholics. A more recent study however [5] showed the prevalence of such lesions to be similar in both alcoholic and nonalcoholic subjects.


Gastric Mucosa Portal Hypertension Esophageal Varix Mucosal Blood Flow Gastric Mucosal Blood Flow 
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  1. 1.
    Preble RB (1900) Conclusions based on 60 cases of fatal gastro-intestinal hemorrhage due to cirrhosis of the liver. Amer J Med Sci 119: 263–280CrossRefGoogle Scholar
  2. 2.
    Dagradi AE, Mehler R, Tan DT, Stempien SJ (1970) Sources of upper gastrointestinal bleeding in patients with liver cirrhosis and large esophagogastric varices. Am J Gastroenterol 54: 458–463PubMedGoogle Scholar
  3. 3.
    Khodadoost J, Glass GBJ (1972) Erosive gastritis and acute gastroduodenal ulcérations as source of upper gastrointestinal bleeding in liver cirrhosis. Digestion 7: 129–138PubMedCrossRefGoogle Scholar
  4. 4.
    Thomas E, Rosenthal WS, Rymer W, Katz D (1979) Upper gastrointestinal haemorrhage in patients with alcoholic liver disease and esophageal varices. Am J Gastroenterol 72: 623–629PubMedGoogle Scholar
  5. 5.
    McCormack TT, Simms J, Eyre-Brook I, Kennedy HJ, Goepel J, Johnson AG, Triger DR (1985) Gastric lesions in portal hypertension: Inflammatory gastritis or congestive gastropathy?. Gut 26: 1226–1232PubMedCrossRefGoogle Scholar
  6. 6.
    Sarfeh IJ, Tarnawski A (1987) Gastric mucosal vasculopathy in portal hypertension. Gastroenterology 93: 1129–1131PubMedGoogle Scholar
  7. 7.
    Papazian A, Braillon A, Dupas JL, Sevenet F, Capron JP (1986) Portal hypertensive gastric mucosa: An endoscopic study. Gut 27: 1199–1203PubMedCrossRefGoogle Scholar
  8. 8.
    Van Vliet ACM, Ten Kate FJV, Dees J, Van Blankenstein M (1978) Abnormal blood vessels of the prepyloric antrum in cirrhosis of the liver as a cause of chronic gastrointestinal bleeding. Endoscopy 10: 89–94PubMedCrossRefGoogle Scholar
  9. 9.
    Hashizume M, Tanaka M, Inokuchi K (1983) Morphology of gastric micro circulation in cirrhosis. Hepatology 3: 1008–1016PubMedCrossRefGoogle Scholar
  10. 10.
    Quintero E, Pique JM, Bombi JA, Bordas JP, Sentis J, Elena M, Bosch J, Ródes J (1987) Gastric mucosal vascular ectasias causing bleeding in cirrhosis. Gastroenterology 93: 1054–1061PubMedGoogle Scholar
  11. 11.
    Corbishley CM, Saverymuttu SH, Maxwell JD (1988) Use of endoscopic biopsy for diagnosing congestive gastropathy. J Clin Pathol 41: 1187–1190PubMedCrossRefGoogle Scholar
  12. 12.
    Foster PN, Wyatt JI, Bullimore DW, Losowsky MS (1989) Gastric mucosa in patients with portal hypertension: Prevalence of capillary dilatation and Campylobacter pylori. J Clin Pathol 42: 919–921PubMedCrossRefGoogle Scholar
  13. 13.
    Sacchetti C, Capello M, Rebecchi P, Roncucci L, Zanghieri G, Tripodi A, Ponz de Leon M (1988) Frequency of upper gastrointestinal lesions in patients with liver cirrhosis. Dig Dis Sci 33: 1218–1222PubMedCrossRefGoogle Scholar
  14. 14.
    Triger DR, Hosking SW (1989) The gastric mucosa in portal hypertension. J Hepatol 8: 267–272PubMedCrossRefGoogle Scholar
  15. 15.
    Triger DR (1989) The natural history and treatment of portal hypertensive gastropathy. J Gastroenterol Hepatol 4: Suppl. 1, 8–14PubMedGoogle Scholar
  16. 16.
    D’Amico G, Traina M, Montalbano L, Madonia S Pagliaro L (1989) Chronic gastric mucosal bleeding in cirrhotic patients with congestive gastropathy. J Hepatol 9 (Suppl 1): S22CrossRefGoogle Scholar
  17. 17.
    Phillips MM, Ramsby GR, Conn HO (1975) Portacaval anastomosis and peptic ulcer: A non-association. Gastroenterol 68: 121–131Google Scholar
  18. 18.
    Lam SK (1976) Hypergastrinaemia in cirrhosis of liver. Gut 17: 700–708PubMedCrossRefGoogle Scholar
  19. 19.
    Imoto I, Yoshida M, Shida Y, Watanabe S, Suzuki S (1989) Campylobacter pylori infection and gastric mucosal lesions in chronic liver diseases. J Gastroenterol Hepatol 4 Suppl. 1, 75–77PubMedGoogle Scholar
  20. 20.
    Pretolani S, Bonvicini F, Baraldini M, Brocchi E, Careddu N, Funaro S, Pasi E, Miglio F, Gasbarrini G (1988) Hypertensive gastritis and Campylobacter pylori colonization in cirrhotic patients. Hepatology 8: 1346Google Scholar
  21. 21.
    Dixon MF, O’Connor HJ, Axon ATR, King RFJG, Johnston D (1986) Reflux oesophagitis: Distinct histopathological entity?. J Clin Pathol 39: 524–530PubMedCrossRefGoogle Scholar
  22. 22.
    Clouse RE, Costigan DJ, Mills BA, Zuckerman GR (1985) Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Int Med 145: 458–461CrossRefGoogle Scholar
  23. 23.
    Haboubi NY, Asquith P (1988) Gastric angiodysplasia associated with primary biliary cirrhosis. Lancet II: 972CrossRefGoogle Scholar
  24. 24.
    Clemente C, Bosch J, Rodes J, Arroyo V, Mas A, Maragall S (1977) Fünctional renal failure and hemorrhagic gastritis associated with endotoxemia in cirrhosis. Gut 18: 556–560PubMedCrossRefGoogle Scholar
  25. 25.
    Wangensteen OH (1945) The ulcer problem. Can Med Assoc J 53: 309–331PubMedGoogle Scholar
  26. 26.
    Palmer ED (1957) Erosive gastritis in cirrhosis. Influence of portal hypertension on the gastric mucosa. Am J Dig Dis 2: 31–36PubMedCrossRefGoogle Scholar
  27. 27.
    Tarnawski A, Sarfeh IJ, Stachura J, Hajduczek A, Bui HX, Dabros W, Gergely H (1988) Microvascular abnormalities of the portal hypertensive gastric mucosa. Hepatology 8: 1488–1494PubMedCrossRefGoogle Scholar
  28. 28.
    Sarfeh IJ, Tarnawski A, Maeda R, Raymont K, Mason GR, Ivey KJ (1984) The gastric mucosa in portal hypertension: Effects of topical bile acid. Scand J Gastroenterol 19 (Suppl 92): 189–194Google Scholar
  29. 29.
    Sarfeh IJ, Tarnawski A, Malki A, Mason GR, Mach T, Ivey KJ (1983) Portal hypertension and gastric mucosal injury in rats: Effects of alcohol. Gastroenterology 84: 987–993PubMedGoogle Scholar
  30. 30.
    Sankary H, Sarfeh IJ, Tarnawski A, Maeda R, Ivey KJ, Mason GR (1986) Propranolol reduces ethanol-induced gastric mucosal damage in portal hypertensive rats. Dig Dis Sci 31: 162–165PubMedCrossRefGoogle Scholar
  31. 31.
    Geoffroy P, Duchateau A, Thiefin G, Zeitoun P (1987) Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats. J Hepatol 5: 162–166PubMedCrossRefGoogle Scholar
  32. 32.
    Sarfeh IJ, Tarnawski A, Hajduczek A, Stachura J, Bui HX, Krause WJ (1988) The portal hypertensive gastric mucosa: Histologic, ultrastructural and functional analysis after aspirin-induced damage. Surgery 104: 79–85PubMedGoogle Scholar
  33. 33.
    Tarnawski A, Sarfeh IJ, Hollander D, Sankary H, Gergely H (1983) Gastric mucosal injury by portal hypertensive rats. Prevention by prostaglandin (cytoprotection) independent of portal pressure (abstract). Gastroenterol 84: 1332Google Scholar
  34. 34.
    Shibayama Y (1986) An experimental study into the casue of acute haemorrhagic gastritis in cirrhosis. J Pathol 149: 307–313PubMedCrossRefGoogle Scholar
  35. 35.
    Groszmann RJ, Colombato LA (1988) Gastric vascular changes in portal hypertension. Hepatology 8: 1708–1710PubMedCrossRefGoogle Scholar
  36. 36.
    Lundgren O (1985) Gastric mucosal haemodynamics. Gastroenterol Clin Biol 9: 26–29PubMedGoogle Scholar
  37. 37.
    Manabe T, Suzuki T, Honjo I (1978) Changes of gastric mucosal blood flow in experimentally induced cirrhosis of the liver. Surg Gynecol Obstet 147: 753–757PubMedGoogle Scholar
  38. 38.
    Nagamine K, Inokuchi K, Sakata H, Beppu K, Koyanagi N, Sugimachi K (1986) Development of erosive gastritis in a canine model of esophageal varices. Jpn J Surg 16: 218–224PubMedCrossRefGoogle Scholar
  39. 39.
    Pique JM, Leung FW, Kitahora T, Sarfeh IJ, Tarnawski A, Guth PH (1988) Gastric mucosal blood flow and acid secretion in portal hypertensive rats. Gastroenterology 95: 727–733PubMedGoogle Scholar
  40. 40.
    Sato N, Kawano S (1989) Gastric mucosal microcirculation disturbances in portal hypertension. J Gastroenterol Hepatol 4: Suppl. 1, 78–80PubMedGoogle Scholar
  41. 41.
    Adachi H, Mitsunaga A, Yokoyama S, Hashimoto H, Hirose M, Kurokawa, K, Obata H (1989) The study of gastric mucosal changes and their mechanism in patients with liver cirrhosis. J Gastroenterol Hepatol 4: Suppl. 1, 96–98PubMedGoogle Scholar
  42. 42.
    Nishiwaki H, Asai T, Sowa T, Umeyama K (1990) Endoscopic measurement of gastric mucosal blood flow with special reference to the effect of sclerotherapy in patients with cirrhosis. Amer J Gastroenterol 85: 34–37Google Scholar
  43. 43.
    Walsh JT, Smart HL, Tindale WB, Triger DR (1988) Gastric mucosal blood flow in portal hypertension. Gut 29: A1461Google Scholar
  44. 44.
    Chung RS, Bruch D, Dearlove J (1988) Endoscopic measurement of gastric mucosal blood flow by laser Doppler velocimetry: Effect of chronic esophageal variceal sclerosis. Am Surg 52: 116–120Google Scholar
  45. 45.
    Eleftheriadis E, Kotzampassi K, Alvanou A, Aletras H (to be published) Blood flow and vascular changes in human portal hypertensive gastric mucosa. Hellenic J GastroenterologyGoogle Scholar
  46. 46.
    Sarfeh IJ, Soliman H, Waxman K, Coccia M, Rypins EP, Bui HX, Tarnawski A (1989) Impaired oxygen of gastric mucosa in portal hypertension. The basis for increased susceptibility to injury. Dig Dis Sci 34: 225–228PubMedCrossRefGoogle Scholar
  47. 47.
    Kameyama J, Suzuki U, Suzuki A, Hoshikawa T, Yasaku U, Toyono M, Ohuchi K, Tsukamoto M, Nishiyama N, Ishihara K, Hotta K (1989) Gastric mucus secretion in portal hypertension. J Gastroenterol Hepatol 4 Suppl. 1, 126–128PubMedGoogle Scholar
  48. 48.
    Blanco CDV, Mele NCA, Romana M, Mancini A, Pastore M (1983) Morphologic and functional damage of gastric mucosa in liver cirrhosis. Panminerva Med 25: 225–229Google Scholar
  49. 49.
    Solis-Herruzo JA, Pardo-Rueda J (1977) Functional study of the gastric mucosal barrier in hepatic cirrhosis. Acta Hepato-gastroenterol 23: 351–359Google Scholar
  50. 50.
    Quintero E, Pique JM, Bombi JA, Ros E, Bordas JM, Rives A, Teres J, Ródes J (1986) Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations. Dig Dis Sci 31: 897–905PubMedCrossRefGoogle Scholar
  51. 51.
    Arakawa A, Satoh H, Fukuda T, Nakamura H, Kobayashi K (1987) Endogenous prostaglandin E2 in gastric mucosa of patients with alcoholic cirrhosis and portal hypertension. Gastroenterology 93: 135–140PubMedGoogle Scholar
  52. 52.
    Reynolds TB, Donovan AJ, Mikkelsen WP, Redeker AG, Turrill FL, Weiner JM (1981) Results of a 12-year randomised trial of portacaval shunt in patients with liver disease and bleeding varices. Gastroenterology 80: 1005–1011PubMedGoogle Scholar
  53. 53.
    Sarfeh IJ, Juler GL, Stemmer EA, Mason GR (1982) Results of surgical management of hemorrhagic gastritis in patients with gastroesophageal varices. Surg Gynecol Obstet 155: 167–170PubMedGoogle Scholar
  54. 54.
    Lebrec D, Poynard T, Hillon P, Benhamou JP (1981) propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis. N Engl J Med 305: 1371–1374PubMedCrossRefGoogle Scholar
  55. 55.
    Hosking SW, Kennedy HJ, Seddon I, Triger DR (1987) The role of propranolol in congestive gastropathy of portal hypertension. Hepatology 7: 437–441PubMedCrossRefGoogle Scholar
  56. 56.
    Lebrec D, Nouel O, Corbic, Benhamou JP (1980) Propranolol—a medical treatment for portal hypertension?. Lancet II: 180–182CrossRefGoogle Scholar
  57. 57.
    Valla D, Bercoff E, Menu Y, Bataille C, Lebrec D (1984) Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis. Gastroenterology 86: 1400–1403PubMedGoogle Scholar
  58. 58.
    Rector WG (1985) Propranolol for portal hypertension. Evaluation of therapeutic response by direct measurement of portal vein pressure. Arch Int Med 145: 648–650CrossRefGoogle Scholar
  59. 59.
    The Italian Multicenter Project for propranolol in prevention of bleeding (1989) Propranolol prevents first gastrointestinal bleeding in non-ascitic cirrhotic patients. J Hepatol 9: 75–83Google Scholar

Copyright information

© Springer Japan 1991

Authors and Affiliations

  • David R. Triger
    • 1
  1. 1.Department of MedicineUniversity of Sheffield Medical School, Royal Hallamshire HospitalSheffieldUK

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