PORTAL-HYPERTENSIVE GASTROPATHY DEVELOPS LESS IN PATIENTS WITH CIRRHOSIS AND FUNDAL VARICES

Background/Aims: The aim of this prospective study was to examine the association of portal-hypertensive gastropathy and fundal varices in p atients with cirrhosis. Methods: We carried out an endoscopic observat ion in 476 patients with cirrhosis (study 1), including 62 patients un dergoing endoscopic obliteration of esophageal varices (study 2). In s tudy 1, patients were classified into five subgroups: no esophagofunda l varices (n = 119), small esophagofundal varices (n = 127), dominant esophageal varices (n = 177), dominant fundal varices (N = 27), and la rge esophagofundal varices (n = 26). The severity of liver dysfunction was assessed by Pugh-Child classification: class A (n = 222), class B (n = 200), and class C (n = 54). In study 2, two groups, poorly devel oped fundal varices (n = 50) and well developed fundal(n = 12), were d istinguished and the follow-up endoscopic examinations were performed on the basis of 3-month intervals for 2 years. In each study the sever ity of portal-hypertensive gastropathy was scored: 0 (absent), 1 (mild ), 2 (severe), and 3 (bleeding). Results: Study 1: One-way ANOVA showe d that both variceal pattern and Pugh-Child class significantly influe nced portal-hypertensive gastropathy score. However, two-way ANOVA ind icated that variceal pattern was the only significant variable. Portal -hypertensive gastropathy score was significantly higher in patients w ith dominant esophageal varices than in either patients with no esopha gofundal varices or patients with small esophagofundal varices. In con trast, portal-hypertensive gastropathy score in patients with dominant fundal varices was similar to that in patients with no esophagofundal varices and was significantly lower compared with that in patients wi th dominant esophageal varices. Furthermore, portal-hypertensive gastr opathy score was significantly lower in patients with large esophagofu ndal varices than in patients with dominant esophageal varices. Study 2: After the obliteration of esophageal varices, portal-hypertensive g astropathy score in patients with poorly developed fundal varices beca me significantly higher at 3-, 6-, 9-months while it was not modified in patients,vith well developed fundal varices during the follow-up pe riod. Furthermore, the integrated incremental change in portal-hyperte nsive gastropathy score during the first 1-year follow-up period was s ignificantly lower in patients with well developed fundal varices than in patients with poorly developed fundal varices. Conclusions: These results indicate that both spontaneous and obliteration-induced portal -hypertensive gastropathy lesions develop less in patients with cirrho sis and fundal varices.