Merli Manuela, Nicolini Giorgia, Angeloni Stefania, Gentili Federica, Attili Adolfo Francesco, Riggio Oliviero
II Gastroenterology Unit, Department of Clinical Medicine, University of Rome La Sapienza, Viale dell'Università 37, 00185 Rome, Italy.
Am J Gastroenterol. 2004 Oct;99(10):1959-65. doi: 10.1111/j.1572-0241.2004.40246.x.
Portal hypertensive gastropathy is a potential cause of bleeding in patients with liver cirrhosis. Studies on its natural history have often included patients submitted to endoscopic or pharmacological treatment for portal hypertension.
A total of 222 cirrhotic patients with mild degree of portal hypertension (i.e., with no or small varices at entry, without previous gastrointestinal bleeding and medical, endoscopic, or angiographic treatment) were followed up with upper endoscopy every 12 months for 47 +/- 28 months.
Upon enrollment 48 patients presented portal hypertensive gastropathy (43 mild and 5 severe) and the presence of esophageal varices was the only independent predictor of the presence of this gastric lesion at multivariate analysis. The incidence of portal hypertensive gastropathy was 3.0% (1.1-4.9%) at 1 yr and 24% (18.1-29.9%) at 3 yr, while the progression was 3% (1-6.9%) at 1 yr and 14% (4.2-23.8%) at 3 yr. The presence of esophageal varices and the Child-Pugh class B or C at enrollment were predictive of the incidence of portal hypertensive gastropathy, while only Child-Pugh class B or C was correlated with the progression from mild to severe, at multivariate analysis. During follow-up 16 patients bled from portal hypertensive gastropathy (9 acutely and 7 chronically) and one patient died of exsanguination from this lesion.
The natural history of portal hypertensive gastropathy is significantly influenced by the severity of liver disease and severity of portal hypertension. Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe.
门脉高压性胃病是肝硬化患者出血的一个潜在原因。关于其自然病程的研究常常纳入了接受内镜或药物治疗门静脉高压的患者。
总共222例轻度门静脉高压的肝硬化患者（即入组时无静脉曲张或有小静脉曲张，既往无胃肠道出血且未接受药物、内镜或血管造影治疗），每12个月接受上消化道内镜检查随访47±28个月。
入组时48例患者存在门脉高压性胃病（43例轻度，5例重度），多因素分析显示食管静脉曲张的存在是该胃部病变存在的唯一独立预测因素。门脉高压性胃病的发病率在1年时为3.0%（1.1 - 4.9%），3年时为24%（18.1 - 29.9%），而进展率在1年时为3%（1 - 6.9%），3年时为14%（4.2 - 23.8%）。多因素分析显示，入组时食管静脉曲张的存在以及Child-Pugh B级或C级可预测门脉高压性胃病的发病率，而只有Child-Pugh B级或C级与从轻度到重度的进展相关。随访期间，16例患者因门脉高压性胃病出血（9例急性出血，7例慢性出血），1例患者死于该病变导致的失血性休克。
门脉高压性胃病的自然病程受肝脏疾病严重程度和门静脉高压严重程度的显著影响。门脉高压性胃病急性出血不常见，但可能很严重。
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