Comparison of portal hypertensive gastropathy and gastric antral vascular ectasia: an update

Abstract

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are two distinct entities that are frequently mistaken with each other, because they present with similar manifestations. This issue may cause catastrophic outcomes, as each one of them has a unique pathophysiology, thereby making their management approaches completely different. There are clinical clues that help physicians distinguish these two. Direct vision via upper endoscopy is often mandatory to establish the diagnosis, and sometimes biopsy is required. In this review, we sought to discuss different aspects of both conditions and highlight clinical evidence that may help in identifying and managing the disease appropriately.

Keywords: Gastric antral vascular ectasia; Portal hypertensive; Portal hypertensive gastropathy.

Figure 1

The endoscopic view of PHG. The pale, pinkish mucosa of the stomach is divided into small polygonal areas by fine, white lines. Also there are some red spot lesions that may be confused with GAVE if there was no typical snakeskin pattern

Figure 2

The typical endoscopic view of GAVE. The red, flat stripes of ectatic vessels radiating from pylorus into the antrum is the most common view observed in most of the GAVE cases

Figure 3

Portal hypertensive gastropathy. Numerous dilated mucosal capillaries impart an edematous appearance to the mucosa

Figure 4

Portal hypertensive gastropathy. Foveolar hyperplasia, regeneration, edema, and a paucity of inflammation, all of which resemble reactive (chemical) gastropathy

Figure 5

Histology of GAVE. Gastric antral mucosa with mildly edematous lamina propria devoid of inflammation, revealing dilated and mildly congested capillaries that the diameter of the lumen approximates the diameter of antral mucosal glands (arrows)

Algorithm 1

Management of PHG

Algorithm 2

Management of GAVE