[Portal hypertensive gastropathy and colopathy]

Abstract

Gastrointestinal bleeding in patients with portal hypertension is usually secondary to esophageal varices, but massive bleeding from gastric mucosal lesions and colonic mucosal lesions including colorectal varices, have been variably described. These lesions are called portal hypertensive gastropathy and colopathy. The incidence and profile of portal hypertensive gastropathy (PHG) has been frequently reported during the last decade, and many studies showed that development of PHG is influenced by coexisting esophageal varices, absence of major portal systemic shunts, severity of liver disease and sclerotherapy and is directly correlated with portal venous pressure. Although hyperdynamic congestion seems to be the underlying mechanisms for the development of PHG, results of gastric mucosal blood flow in patients with PHG is controversial. The treatment can be currently recommended to prevent bleeding, is oral administration of propranolol which decreased portal venous pressure. The clinical feature and profile of portal hypertensive colopathy is classified two groups, which are named colorectal varices and colonic mucosal lesions including vascular spider, dilated fine branching vessels. Although colorectal varices are usually seen at rectum and sigmoid colon, colonic mucosal lesions are seen all part of colon. Significant relationship between colorectal varices and liver disease has been reported and colorectal varices is highly appeared in patients with extrahepatic portal obstruction. Such patients are revealed arteriovenous communications at angiogram. In general, colonic resection or transanal ligation should be the first option for treatment of bleeding colonic varices and colonic mucosal lesions. Transendoscopic sclerotherapy may be an alternate choice.