Primignani M, Carpinelli L, Preatoni P, Battaglia G, Carta A, Prada A, Cestari R, Angeli P, Gatta A, Rossi A, Spinzi G, De Franchis R
Department of Internal Medicine, University of Milan, and Gastroenterology and Gastrointestinal Endoscopy Service, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.
Gastroenterology. 2000 Jul;119(1):181-7. doi: 10.1053/gast.2000.8555.
BACKGROUND & AIMS: 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.
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.
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%).
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.
门脉高压性胃病（PHG）作为肝硬化患者胃肠道出血来源的临床重要性尚未明确界定。我们在一大组患者中研究了这种疾病的自然病程。
对1992年6月和7月在7家医院就诊的所有肝硬化患者每6个月进行一次临床和内镜检查，随访长达3年。根据新意大利内镜俱乐部的分类法对胃病进行分类。
胃病的患病率为80%，与病程、食管胃静脉曲张的存在及大小以及既往内镜下静脉曲张硬化治疗史相关。在18±8个月的随访期间，29%的患者胃病稳定，23%的患者病情恶化，23%的患者病情改善，25%的患者病情随时间波动。有或无既往或当前硬化治疗的患者，胃病随时间的演变情况相同。315例患者中有8例（2.5%）发生了因胃病导致的急性出血。出血相关死亡率为12.5%。34例患者（10.8%）发生了慢性出血。
PHG在肝硬化患者中很常见，其患病率与门脉高压的严重程度平行。胃病可由轻变重，反之亦然，甚至可完全消失。这种病变引起的出血相对少见，且很少严重。食管静脉曲张硬化治疗似乎不影响这种疾病的自然病程。
