The natural history of portal hypertensive gastropathy: Influence of variceal eradication

OBJECTIVE: The natural history and likelihood of bleeding from portal hyper tensive gastropathy (PHG) present in patients with portal hypertension befo re endoscopic variceal obliteration may differ from that in patients who de velop PHG during or after variceal eradication. METHODS: A total of 967 variceal bleeders who had achieved variceal eradica tion by endoscopic sclerotherapy in the recent past were prospectively stud ied. In all, 88 (9.1%) patients (cirrhosis in 54, noncirrhotic portal fibro sis in 18, and extrahepatic portal vein obstruction in 16) had distinct muc osal lesions. PHG alone was present in 78, PHG with gastric antral vascular ectasia (GAVE) in eight, and GAVE alone in two patients. PHG was graded as mild or severe and according to whether present before (group A) or after endoscopic intervention (group B). Patients underwent regular endoscopy at follow-up to see if the PHG was transitory (disappearing within 3 months), persistent (no change), or progressive. Bleeding from PHG lesions was defin ed as acute or chronic. RESULTS: Twenty-two (26%) patients had PHG before (group A) and 64 (74%) de veloped PHG after variceal eradication (group B). During a mean follow-up o f 25.1 +/- 14.2 months, PHG lesions disappeared in group A in only two pati ents (9%), but in group B in 28 (44%) patients (p < 0.05). PHG lesions more often progressed in the former as compared to the latter (18% vs 9.4%), p = NS). The incidence of bleeding was higher in group A than group B (32% vs 4.7%, p < 0.02). Bleeding from PHG occurred in 10 patients (11.6%); seven of them were from group A, and all had either progressive (n = 3) or persis tent (n = 4) lesions. CONCLUSIONS: PHG developing after variceal eradication is often transitory and less severe. If PHG is pre-existing, endoscopic therapy for varices cou ld worsen the PHG, with a likelihood of bleeding. Such patients may be bene fited by concomitant beta-blocker therapy. (Am J Gastroenterol 2000;95:2888 -2893. (C) 2000 by Am. Coll. of Gastroenterology).