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by Jones P

Definition

Portal hypertensive gastropathy (PHG) is a change in the tissue that lines the stomach. It leads to wounds in the stomach.

Gastric Ulcer
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Causes

It is not clear exactly what causes PHG. It is linked to portal hypertension. This is high pressure in a blood vessel that takes blood from the intestines and stomach to the liver. The pressure causes a backup of blood flow to the stomach and intestines. Blood vessels in the stomach can swell and leak. This may lead to irritation and PHG.

Risk Factors

Factors that may increase your risk of PHG include:

  • Severe liver disease
  • Previous endoscopy to stop bleeding in the stomach

Symptoms

PHG may not always cause symptoms. Bleeding can sometimes happen. This can lead to:

  • Vomiting blood or coffee ground like vomit
  • Black tarry stool
  • Fatigue, weakness, or lightheadedness (if you have low red blood cell level due to blood loss)

Diagnosis

You will be asked about symptoms and past health. A physical exam will be done.

An endoscopy will be done. It will let the doctor view the area. A diagnosis can be made based on the appearance of the lining.

Treatment

The first step of treatment is to control the portal hypertension. It may include:

  • Medicine is the first line of treatment. A type of beta-blocker is the most common choice.
  • Surgery may be needed for severe blood flow problems. A shunt can improve blood flow to the liver. The stomach can heal with time after the portal hypertension is managed.

Support may be needed if there is severe bleeding. It may include:

  • Emergency care
  • Iron supplements for anemia

Prevention

There are no guidelines to prevent portal gastropathy.

RESOURCES

American Gastroenterological Association  http://www.gastro.org 

American Liver Foundation  http://www.liverfoundation.org 

CANADIAN RESOURCES

Canadian Liver Foundation  https://www.liver.ca 

Canadian Digestive Health Foundation  http://www.cdhf.ca 

References

Acute nonvariceal upper gastrointestinal bleeding. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T435298/Eosinophilic-esophagitis-in-children . Updated October 1, 2018. Accessed June 7, 2019.

Cubillas R, Rockey DC. Portal hypertensive gastropathy: a review. Liver Int. 2010 Sep;30(8):1094-102. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20536720. Accessed June 7, 2019.

Ripoll C, Garcia-Tsao G. Management of Gastropathy and Gastric Vascular Ectasia in Portal Hypertension. Clin Liver Dis. 2010 May; 14(2): 281–295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916868/. Accessed June 7, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board
  • Review Date: 12/2019
  • Update Date: 01/10/2020