Portal hypertensive gastropathy a clinically significant puzzle

In this review the updated information concerning the influence of portal hypertension on gastric mucosa is presented. The term portal hypertensive gastropathy [PHG] defines a wide spectrum of endoscopic lesions that appear in the gastric mucosa of cirrhotic patients and which should be differentiated from gastric antral vascular ectasia. These endoscopic findings correspond to dilated mucosal and submucosal vessels in the absence of inflammation. There is wide variation in the prevalence of PHG, but its natural history in not clearly documented. Endoscopic variceal obliteration may contribute to the development or aggravation of these lesions. Similar influence of portal hypertension seems to be extended in the lower gastrointestinal tract. With regard to gastric mucosal hemodynamics, it is not known whether active congestion or passive congestion causes gastric mucosal hyperhemia. The pathogenesis of PHG in not well known, but both venous congestion related to raised portal pressure and increased gastric blood flow seem to be crucial factors for its development. Gastric mucosal defense mechanisms are impaired in PHG. Bleeding is its unique clinical manifestation and occurs in patients with severe lesions. Pharmacological, surgical and interventional radiological procedures are available for the treatment of bleeding PHG, but the treatment needs to be improved.