Portal Hypertension and Hypertensive Gastropathy Clinical Aspects

■ Causes and Findings

Hypertensive gastropathy (Fig. 3.114). Hypertensive gastropathy is seen in patients with portal hypertension. While histology shows scant inflammatory mucosal infiltrate, the gastric mucosa exhibits significant epithelial or vascular damage. Given the nondescript histological changes, the diagnosis is based primarily on endoscopic findings.

Gastric antral venous ectasia (GAVE) syndrome (Fig. 3.115). GAVE syndrome refers to the ectatic dilatation of venous plexuses in the gastric antrum due to portal hypertension (synonym: "watermelon stomach"). Oozing hemorrhages are not uncommon.

Varices (Fig. 3.116). Patients with portal hypertension sometimes develop varices in the gastric fundus and cardia, which accompany the esophageal varices. Isolated gastric varices are sometimes found in association with splenic vein thrombosis, which is usually secondary to a tumor or pancreatitis. In rare cases, veins showing varixlike dilatation may extend into the gastric body, antrum, and duodenum.

Prophylactic endoscopic treatment is not recommended. Bleeding varices in the fundus and cardia are discussed on page 150.

Fig. 3.114a-d Hypertensive gastropathy. Pronounced snakeskin-like pattern of mucosal markings

Fig. 3.114a-d Hypertensive gastropathy. Pronounced snakeskin-like pattern of mucosal markings

Was this article helpful?

0 0

Post a comment