PORTAL HYPERTENSIVE GASTROPATHY IN NONCIRRHOTIC PATIENTS - THE EFFECTOF LIENORENAL SHUNTS

We studied 25 consecutive patients with noncirrhotic portal hypertensi on to determine whether portal hypertensive gastropathy occurred and w hether it was related to hypoacidity, hypergastrinemia, or portal veno us congestion, Preoperative tests included, gastrointestinal endoscopy , gastric mucosal biopsies, gastric acid estimation, and serum gastrin measurements, All patients had a central splenorenal shunt performed during which a full-thickness gastric biopsy was performed. The tears were repeated 3 to 16 months postoperatively, Eight of the 25 patients showed endoscopic evidence of portal hypertensive gastropathy. The sh unt procedure reversed the gastropathy in 6 of 7 patients followed up. Mucosal biopsies revealed vascular ectasia In 24 of 25 patients; in 8 of the most severely affected there ii-as partial or complete regress ion after surgery, The basal and peak acid output in the patients were normal for our laboratory at 2.9 +/- 0.25 meq/hour and 16.37 +/- 0.96 meq/hour, respectively. They remained unchanged after surgery. Fastin g serum gastrin levels were also normal both before and after surgery. Our findings indicate that venous congestion is the cause of portal h ypertensive gastropathy in patients with noncirrhotic portal hypertens ion and that it fan he reversed by a decompressive procedure.