Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Table 10 Differences in gastrointestinal bleeding from portal hypertensive gastropathy vs esophageal varices

Parameter	Portal hypertensive gastropathy	Esophageal varices
Etiology	Portal hypertension: Cirrhotic or non-cirrhotic	Portal hypertension: Cirrhotic or non-cirrhotic
Concurrence	Frequently occur simultaneously with esophageal varices because the two diseases share common risk factors	Frequently occurs simultaneously with PHG because the two diseases have common risk factors
Location	Stomach: Predominantly fundus and body	Distal esophagus: Also can have gastric varices or ectopic varices in other gastrointestinal regions, particularly duodenum
Diagnosis	Esophagogastroduodenoscopy	Esophagogastroduodenoscopy
Endoscopic appearance	Erythematous small polygonal areas of mucosa surrounded by a fine, whitish, reticular or mosaic/snakeskin mucosa with red or brown spots	Serpiginous mucosal greyish luminal projections in distal esophagus
Clinical presentation	Mild acute or chronic bleeding	Acute gastrointestinal bleeding-typically massive
Severity of bleeding	Typically mild and not life-threatening	Typically severe and life-threatening
Histology		Not biopsied at endoscopy
Endoscopic therapy	Limited role	Variceal ligation recommended as initial therapy. Sclerotherapy an alternative therapy
Medical therapy	Octreotide	Octreotide
	Propranolol	Propranolol
	Vasopressin or vasopressin analogues-infrequently recommended any more	Vasopressin or vasopressin analogues-infrequently recommended any more
Blakemore tube	Not recommended	Sometimes used for refractory bleeding especially as a temporizing measure before performing more definitive therapy
Angiographic therapy	TIPS used as a last resort	TIPS recommended if endoscopic therapy fails
Transfusion of packed erythrocytes	Transfuse only to hematocrit of about 28. Over-transfusion may increase portal pressure and induce greater bleeding	Transfuse only to hematocrit of about 28. Over-transfusion may increase portal pressure and induce greater bleeding
Liver transplantation	Improves or resolves with liver transplantation	Improves or resolves with liver transplantation
Prognosis	Rarely fatal	Frequently fatal

TIPS: Transjugular intrahepatic portosystemic shunt; PHG: Portal hypertensive gastropathy.