title: The spectrum of gastric pathology in portal hypertension-An endoscopic and pathologic study of 550 cases.
abstract: One of the main tasks for pathologists when evaluating gastric biopsies from patients with portal hypertensive gastropathy (PHG) is to examine whether there is increased mucosal vasculature as suggested by endoscopy. However, the full spectrum of pathology findings in patients with portal hypertension (pHTN) is largely unknown. We systematically characterized the endoscopic and pathologic features in gastric biopsies from pHTN patients (study group) and compared with those from patients without pHTN (control group). The study group consisted of 550 consecutive surveillance esophagogastroduodenoscopic (EGD) biopsies, whereas the control group included 281 consecutive EGD biopsies for a variety of indications. As expected, the endoscopic prevalence of PHG was 28%, among which two-thirds showed corresponding histopathologic evidence of increased vasculature. However, non-Helicobacter pylori gastritis was the most common finding in pHTN patients on histology (40%). In addition, hyperplastic polyp was also more common in pHTN patients than in controls (6% vs 3%; P=0.0314). In contrast, pathology findings of nonspecific reactive changes (29% vs 51%; P<0.0001), proton pump inhibitor-related changes (16% vs 30%; P<0.0001), and malignancy (1% vs 3%; P=0.0138) were less common in pHTN patients. Our results show a spectrum of gastric endoscopic and pathologic findings in pHTN patients. The predominant gastric pathology in pHTN patients may be associated with pHTN-induced gastric microcirculation impairment.
authors.affiliation: Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States. Electronic address: mac2@upmc.edu.
authors.forename: Changqing
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Medicine, Gastroenterology Division, Washington University School of Medicine, Saint Louis, MO 63110, United States.
authors.forename: Chien-Huan
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States. Electronic address: tliu@path.wustl.edu.
authors.forename: Ta-Chiang
authors.initials: TC
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology*; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000473:pathology*; D055815:Young Adult
keywords: Biopsy; Cirrhosis; Gastric antral vascular ectasia; Non-Helicobacter pylori gastritis