Systematic Reviews
Copyright ©The Author(s) 2016.
World J Hepatol. Feb 8, 2016; 8(4): 231-262
Published online Feb 8, 2016. doi: 10.4254/wjh.v8.i4.231
Table 9 Differences between portal hypertensive gastropathy and gastric antral vascular ectasia
ParameterPortal hypertensive gastropathyGastric antral vascular ectasiaRef.
Associated conditionsConditions associated with portal hypertension: cirrhotic or non-cirrhotic portal hypertensionCirrhosis, autoimmune disorders, and connective tissue diseases (scleroderma, pernicious anemia, hypothyroidism)[72]
Association with portal hypertensionStrong associationOnly 30% of cases[191,192]
SexMildly more common in males (alcoholic cirrhosis more common in males than females)Much more common in females (80%)[193,194]
AgeCan occur at any age in patients with portal hypertension or cirrhosisTypically elderly (average age > 70 years old)
LocationProximal stomach: Fundus, bodyDistal stomach: Antrum[72,192]
DiagnosisEndoscopy (endoscopic biopsy sometimes useful). Radiologic imaging usually not helpfulEndoscopy (endoscopic biopsy sometimes useful)[72,195]
Appearance at endoscopyMosaic/snakeskin mucosa with red or brown spotsTortuous columns of ectatic vessels in "watermelon" or diffuse pattern; erythematous or hemorrhagic[191]
HistologyEctatic capillaries, mildly dilated mucosal and submucosal veins; no vascular inflammation, no vascular thrombiMarked dilation of capillaries and venules in gastric mucosa and submucosa with areas of intimal thickening, fibrin thrombi, fibromuscular hyperplasia and spindle cell proliferation[72,191,196,197]
Clinical presentation/ complicationsGastrointestinal bleeding: Usually chronic, but sometimes acuteAlmost exclusively chronic gastrointestinal bleeding with guaiac positive stools[37,193]
Primary prophylaxisNot indicatedNot indicated (unless associated with large varices)[198]
Medical therapyNon-selective β-adrenergic receptor antagonists (propranolol), octreotide (for acute bleeding)No benefit of β-adrenergic receptor antagonists[103,106,198-201]
Oral contraceptive pills to temporarily control bleeding
Questionable benefit of octreotide
Endoscopic therapyOccasionally helpful (for focal bleeding)Very helpful at reducing risk of bleeding: Argon plasma coagulation; EBL; Radiofrequency ablation; YAG laser therapy[202-207]
Argon plasma coagulation
Local hemostasis with hemospray
TIPSSignificantly reduces severity and risk of bleeding by reducing portal hypertension. Option for very severe bleeding from PHG or for moderate PHG in patients with variceal bleedingNot recommended. Does not affect severity of GAVE or risk of bleeding[75,77]
Liver transplantationResolves. Ultimate therapy mostly reserved for patients with end-stage liver diseaseImproves or resolves with liver transplantation[75,200,208-210]
Other surgeryUsually resolves with shunt surgery that lowers portal pressure. Partial gastrectomy not recommendedLimited surgical resection (partial gastrectomy) recommended for refractory cases. Shunt surgery not recommended[75,200,211-213]
Prognosis from bleedingBleeding rarely severe and very rarely fatalBleeding occasionally severe[34,71,72]