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Review
. 2014 May;18(2):389-406.
doi: 10.1016/j.cld.2014.01.008.

Portal hypertensive gastropathy and colopathy

Nathalie H Urrunaga  1 , Don C Rockey  2
Affiliations
Review

Portal hypertensive gastropathy and colopathy

Nathalie H Urrunaga et al. Clin Liver Dis. 2014 May.

Abstract

Portal hypertensive gastropathy (PHG) and colopathy (PHC) are considered complications of portal hypertension. Both entities are clinically relevant because they may cause insidious blood loss or even acute massive gastrointestinal hemorrhage. Endoscopic evaluation is necessary for the diagnosis of PHG and PHC. The existence of different endoscopic criteria for PHG and PHC makes consensus difficult and results in a broad range of reported prevalence. Therapy targeted at reduction of portal pressure and mucosal blood flow has been used to treat acute bleeding; nonselective β-blockers are the most frequently used agents. Further studies are needed to clarify the natural history, pathogenesis, and treatment of PHG and PHC.

Keywords: Bleeding; Cirrhosis; Hemorrhage; Portal hypertension; Pressure.

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Conflict of interest statement

Disclosure of Conflicts: The authors certify that they have no financial arrangements (eg, consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, major honoraria, and so forth).

Figures

Fig. 1
Fig. 1
(A, B) Representative images of mild PHG. A shows a forward-viewing image of the proximal stomach. B shows a retroflex view of the cardia with the classic form of PHG, the typical “mosaic-like pattern” without significant stigmata of bleeding or erythema or edema. (C, D) Representative images of severe PHG. Red lesions of variable diameter are evident. There is often irregular mucosa. Cherry spots may be confluent or not. Slow oozing may also be seen as in D, an up-close view in the proximal stomach.
Fig. 2
Fig. 2
PHG management. Recommended approaches to therapy are shown. It is recommended to manage PHC similarly, although in patients with PHC, management is typically more individualized. APC, argon plasma coagulation.
Fig. 3
Fig. 3
Image of the colonic mucosa, depicting an area with multiple localized flat red lesions, typical of PHC. (Courtesy of A. Brock, MD, Charleston, SC.)
See this image and copyright information in PMC

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