Natural history of portal hypertensive gastropathy in patients with liver cirrhosis

Background & Aims: The clinical importance of portal hypertensive gastropat hy (PHG) as a source of gastrointestinal bleeding in patients with cirrhosi s is poorly defined, We investigated the natural history of this condition in a large series of patients, Methods: All patients with cirrhosis seen at 7 hospitals during June and July 1992 were Followed up with clinical and e ndoscopic examinations every 6 months for up to 3 years. Gastropathy was cl assified according to the classification of the New Italian Endoscopic Club . Results: The prevalence of gastropathy was 80% and was correlated with th e duration of disease, presence and size of esophagogastric varices, and a previous history of endoscopic variceal sclerotherapy, During 18 +/- 8 mont hs of follow-up, gastropathy was stable in 29% of patients, deteriorated in 23%, improved in 23%, and fluctuated with time in 25%, The evolution of ga stropathy with time was identical in patients with and without previous or current sclerotherapy. Acute bleeding from gastropathy occurred in 8 of 315 patients (2.5%). The bleeding-related mortality rate was 12.5%, Chronic bl eeding occurred in 34 patients (10.8%). Conclusions: PHG is common in patie nts with cirrhosis, and its prevalence parallels the severity of portal hyp ertension. Gastropathy can progress from mild to severe and vice versa or e ven disappear completely. Bleeding from this lesion is relatively uncommon and rarely severe, Sclerotherapy of esophageal varices does not seem to inf luence the natural history of this condition.