Sarin S K, Shahi H M, Jain M, Jain A K, Issar S K, Murthy N S
Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
Am J Gastroenterol. 2000 Oct;95(10):2888-93. doi: 10.1111/j.1572-0241.2000.03200.x.
The natural history and likelihood of bleeding from portal hypertensive gastropathy (PHG) present in patients with portal hypertension before endoscopic variceal obliteration may differ from that in patients who develop PHG during or after variceal eradication.
A total of 967 variceal bleeders who had achieved variceal eradication by endoscopic sclerotherapy in the recent past were prospectively studied. In all, 88 (9.1%) patients (cirrhosis in 54, noncirrhotic portal fibrosis in 18, and extrahepatic portal vein obstruction in 16) had distinct mucosal lesions. PHG alone was present in 78, PHG with gastric antral vascular ectasia (GAVE) in eight, and GAVE alone in two patients. PHG was graded as mild or severe and according to whether present before (group A) or after endoscopic intervention (group B). Patients underwent regular endoscopy at follow-up to see if the PHG was transitory (disappearing within 3 months), persistent (no change), or progressive. Bleeding from PHG lesions was defined as acute or chronic.
Twenty-two (26%) patients had PHG before (group A) and 64 (74%) developed PHG after variceal eradication (group B). During a mean follow-up of 25.1 +/- 14.2 months, PHG lesions disappeared in group A in only two patients (9%), but in group B in 28 (44%) patients (p < 0.05). PHG lesions more often progressed in the former as compared to the latter (18% vs 9.4%, p = NS). The incidence of bleeding was higher in group A than group B (32% vs 4.7%, p < 0.02). Bleeding from PHG occurred in 10 patients (11.6%); seven of them were from group A, and all had either progressive (n = 3) or persistent (n = 4) lesions.
PHG developing after variceal eradication is often transitory and less severe. If PHG is pre-existing, endoscopic therapy for varices could worsen the PHG, with a likelihood of bleeding. Such patients may be benefited by concomitant beta-blocker therapy.
门静脉高压患者在内镜下静脉曲张消除术前存在的门静脉高压性胃病（PHG）的自然病程及出血可能性，可能与在静脉曲张消除期间或之后发生PHG的患者不同。
对近期通过内镜硬化疗法实现静脉曲张消除的967例静脉曲张出血患者进行前瞻性研究。共有88例（9.1%）患者（54例肝硬化，18例非肝硬化门静脉纤维化，16例肝外门静脉阻塞）有明显的黏膜病变。仅PHG患者78例，PHG合并胃窦血管扩张（GAVE）患者8例，仅GAVE患者2例。PHG分为轻度或重度，并根据内镜干预前（A组）或后（B组）是否存在进行分类。患者在随访期间接受定期内镜检查，以观察PHG是短暂性的（3个月内消失）、持续性的（无变化）还是进行性的。PHG病变出血定义为急性或慢性。
22例（26%）患者在静脉曲张消除前（A组）有PHG，64例（74%）在静脉曲张消除后发生PHG（B组）。在平均25.1±14.2个月的随访期间，A组仅2例（9%）患者的PHG病变消失，而B组有28例（44%）患者的病变消失（p<0.05）。与后者相比，PHG病变在前者中更常进展（18%对9.4%，p=无统计学意义）。A组的出血发生率高于B组（32%对4.7%，p<0.02）。10例（11.6%）患者发生PHG出血；其中7例来自A组，且均有进行性（n=3）或持续性（n=4）病变。
静脉曲张消除后发生的PHG通常是短暂性的且不太严重。如果PHG是预先存在的，内镜下静脉曲张治疗可能会使PHG恶化，并增加出血可能性。此类患者可能从联合使用β受体阻滞剂治疗中获益。
