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

Table 4 Effects of variceal sclerotherapy on frequency of portal hypertensive gastropathy

Ref.	No. of patients and etiology	Study type	PHG before procedure	PHG aggravation after procedure	P value
Hou et al[73]	90 cirrhotic patients with recent variceal bleeding; EVS 44, EVL 46	Randomized, controlled trial	Pre EVS group: 6 none/24 mild/14 severe; pre EVL group: 4 none/33 mild/9 severe; total: 10 none/57 mild/23 severe	At eradication: 14/29 (48.3%) in EVS; 17/37 (45.9%) in EVL; at 3 mo: 15/26 (57.7%) in EVS; 17/30 (56.7%) in EVL; at 6 mo 15/25 (60%) in EVS; 18/29 (62.1%) in EVL	Non-significant difference in PHG aggravation between EVS and EVL; P > 0.05
Itha et al[11]	163 children with extrahepatic portal vein obstruction presenting with variceal bleeding underwent endoscopic injection sclerotherapy	Not reported	12% overall PHG (actual number not stated), 1 patient with severe PHG	41% overall PHG (actual number not stated), 12 patients with severe PHG	P < 0.001 for overall PHG; P < 0.001 for severe PHG
Poddar et al[83]	186 children with extrahepatic portal vein obstruction presenting with variceal bleeding undergoing endoscopic sclerotherapy, and mean follow up of 38 ± 30 mo	Retrospective study	PHG: 46/186 (24.7%), severe PHG: 6/186 (3.2%)	PHG: 96/186 (51.6%), severe PHG: 29/186 (15.6%)	P < 0.001 for overall PHG; P < 0.05 for severe PHG
Yüksel et al[41]	114 patients with cirrhosis and portal hypertension undergoing EVS (29/114) or EVL (85/114)	Retrospective study	Pre EVS group: 11/29 (37.9%) none; 10/29 (24.5%) mild; 8/29 (27.6%) severe; pre EVL group: 27/85 (31.8%) none; 28/85 (32.9%) mild; 30/85 (35.3%) severe	Post EVS group: 4/29 (13.8%) none; 8/29 (27.6%) mild; 17/29 (58.6%) severe; post EVL group: 14/85 (16.5%) none; 30/85 (35.3%) mild; 41/85 (48.2%) severe	Pre EVS vs post EVS; P < 0.05; pre EVL vs post EVL; P < 0.05; pre EVS vs pre EVL; P > 0.05; post EVS vs post EVL; P > 0.05
Sarin et al[10]	967 patients with variceal bleeding underwent endoscopic sclerotherapy; out of whom 88 patients fulfilled the inclusion criteria (including presence of endoscopic lesions consistent with PHG or GAVE, before or within 4 wk after obliteration) were prospectively followed (out of whom 2 had only GAVE)	Prospective study	22 patients had PHG prior to EVS; 2/22 transient (9%); 17/22 persistent (77%); 3/22 progressive (14%)	Additional development in 64 patients post procedure, 28/64 transient (44%), 31/64 persistent (48%), 5/64 progressive (8%)	Only statistically significant difference was the transient PHG that disappeared in 28 (44%) of patients in the group that developed PHG post procedure; P < 0.05
Gupta et al[30]	230 patients with liver cirrhosis; of which 44 underwent variceal eradication with sclerotherapy	Prospective study	24/44 (54%)	33/44 (75%)	P < 0.05
Sarin et al[8]	107 patients with portal hypertension presenting with variceal bleeding that underwent sclerotherapy with mean follow-up of 23.2 ± 3.4 mo	Prospective study	4/107 (3.7%)	21 additional patients, 25/107 (23%)	Does not state if this was statistically significant
de la Peña et al[82]	93 patients with history of variceal hemorrhage and cirrhosis, randomized to receive either EVS (46/88) or EVL (42/88); 5 patients were excluded due to diagnosis of hematoma, non-cirrhotic portal hypertension or portal vein thrombosis	Prospective study	Not reported	PHG worsened in 23 patients total; statistically significantly more in EVL group than EVS group (17 vs 6 patients respectively)	P < 0.01
D'Amico et al[25]	212 cirrhotic patients of which 75 had an episode of variceal bleeding and were treated with sclerotherapy; 137 without bleeding were not treated with sclerotherapy	Prospective study	No EVS group at admission: 104/137 (75%) none; 28/137 (20%) mild; 5/137 (4%) severe; EVS group at admission: 50/75 (66%) none; 17/75 (22%) mild; 8/75 (11%) severe	No EVS group at end of study 69/137 (50%) none; 61/137 (45%) mild; 7/137 (5%) severe; EVS group at end of study: 13/75 (17%) none; 49/75 (65%) mild; 13/75 (17%) severe	The conclusion was that sclerotherapy is a significant indicator of the risk of PHG in a multivariate analysis (P = 0.00032)

PHG: Portal hypertensive gastropathy; EVL: Endoscopic variceal ligation; EVS: Endoscopic variceal sclerotherapy.