Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis

Background & Aims: The response of gastric mucosal lesions in cirrhotic pat ients with portal hypertension, namely, portal hypertensive gastropathy (PH G) and gastric vascular ectasia (GVE), to transjugular intrahepatic portosy stemic shunts (TIPS) is not known. Methods: Clinical and laboratory evaluat ion, upper gastrointestinal endoscopy, and Doppler ultrasonography were per formed before placement of TIPS and 6 weeks, 3 months, and 6 months after T IPS in 54 patients. Thirty patients had mild PHG, 10 had severe PHG, and 14 had GVE. Results: Approximately 75% of the patients with severe PHG respon ded to TIPS as shown by improvement in endoscopic findings and by a decreas e in transfusion requirements; 89% of patients with mild PHG had endoscopic resolution. Patients with GVE had neither endoscopic resolution nor a decr ease in transfusion requirements after TIPS. There was no difference in mor tality between the 2 groups, Conclusions: The results support the position that severe PHG and GVE may be different lesions. Mild and severe PHG respo nd to TIPS. Because GVE does not respond to TIPS, we recommend that TIPS be avoided for the treatment of gastrointestinal bleeding associated with GVE .