SHORT-TERM EFFECTS OF VARICEAL SCLEROTHERAPY ON PORTAL HYPERTENSIVE GASTROPATHY

Background and Study Aims: Obliteration of esophageal varices may modi fy the mucosal perfusion of the stomach. The relationship between shor t-term injection variceal sclerotherapy (IVS) and the evolution of por tal hypertensive gastropathy (PHG) is insufficiently recognized. Patie nts and Methods: Forty-one cirrhotic patients were treated with hemost atic or secondary preventive TVS. They underwent sclerotherapy at inte rvals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system as signing 0 points for a normal mucosal image, 1 point for reddened, 2 p oints for a mosaic-like mucosal pattern, and 3 points for a mosaic-lik e pattern plus red marks in the stomach. All patients received propran olol after the first sclerotherapy session. Results: The total score b efore IVS was 45 points (1.1 points per patient). After 188 sclerother apy sessions (2-8 per patient), the score significantly increased to 7 3 points (1.8 points per patient, P=0.04). This effect was particularl y marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P=0.01), and negligible in patients with either less o r more advanced cirrhosis (Child-Pugh classes A and C). Conclusions: I n patients with cirrhosis, short-term IVS may contribute to the mechan isms of progressive PHG.