Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis.
OBJECTIVE
The response of gastric mucosal lesions in cirrhotic patients with portal hypertension, namely, portal hypertensive gastropathy (PHG) and gastric vascular ectasia (GVE), to transjugular intrahepatic portosystemic shunts (TIPS) is not known.


METHODS
Clinical and laboratory evaluation, upper gastrointestinal endoscopy, and Doppler ultrasonography were performed before placement of TIPS and 6 weeks, 3 months, and 6 months after TIPS 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 responded to TIPS as shown by improvement in endoscopic findings and by a decrease in transfusion requirements; 89% of patients with mild PHG had endoscopic resolution. Patients with GVE had neither endoscopic resolution nor a decrease in transfusion requirements after TIPS. There was no difference in mortality between the 2 groups.


CONCLUSIONS
The results support the position that severe PHG and GVE may be different lesions. Mild and severe PHG respond to TIPS. Because GVE does not respond to TIPS, we recommend that TIPS be avoided for the treatment of gastrointestinal bleeding associated with GVE.
Kamath
P S
PS
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA. kamath.patrick@mayo.edu
Lacerda
M
M
Ahlquist
D A
DA
McKusick
M A
MA
Andrews
J C
JC
Nagorney
D A
DA
D000368:Aged; D001803:Blood Transfusion; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D005773:Gastroscopy; D006454:Hemoglobins; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D013272:Stomach Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018608:Ultrasonography, Doppler
D006454:Hemoglobins