title: Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC).
abstract: OBJECTIVE
  The clinical importance of portal hypertensive gastropathy (PHG) as a source of gastrointestinal bleeding in patients with cirrhosis 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 endoscopic examinations every 6 months for up to 3 years. Gastropathy was classified according to the classification of the New Italian Endoscopic Club.
  
  
  RESULTS
  The prevalence of gastropathy was 80% and was correlated with the duration of disease, presence and size of esophagogastric varices, and a previous history of endoscopic variceal sclerotherapy. During 18+/-8 months 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 gastropathy 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 bleeding occurred in 34 patients (10.8%).
  
  
  CONCLUSIONS
  PHG is common in patients with cirrhosis, and its prevalence parallels the severity of portal hypertension. Gastropathy can progress from mild to severe and vice versa or even disappear completely. Bleeding from this lesion is relatively uncommon and rarely severe. Sclerotherapy of esophageal varices does not seem to influence the natural history of this condition.
authors.affiliation: Department of Internal Medicine, University of Milan, and Gastroenterology and Gastrointestinal Endoscopy Service, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Primignani
authors.forename: L
authors.initials: L
authors.lastname: Carpinelli
authors.forename: P
authors.initials: P
authors.lastname: Preatoni
authors.forename: G
authors.initials: G
authors.lastname: Battaglia
authors.forename: A
authors.initials: A
authors.lastname: Carta
authors.forename: A
authors.initials: A
authors.lastname: Prada
authors.forename: R
authors.initials: R
authors.lastname: Cestari
authors.forename: P
authors.initials: P
authors.lastname: Angeli
authors.forename: A
authors.initials: A
authors.lastname: Gatta
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Spinzi
authors.forename: R
authors.initials: R
authors.lastname: De Franchis
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008107:Liver Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013272:Stomach Diseases / Q000209:etiology*