Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Clin Mol Hepatol. 2014 Mar;20(1):1-5. doi: 10.3350/cmh.2014.20.1.1. Epub 2014 Mar 26.
A major cause of cirrhosis related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Less common causes of gastrointestinal bleeding are peptic ulcers, malignancy, angiodysplasia, etc. Upper gastrointestinal bleeding has been classified according to the presence of a variceal or non-variceal bleeding. Although non-variceal gastrointestinal bleeding is not common in cirrhotic patients, gastroduodenal ulcers may develop as often as non-cirrhotic patients. Ulcers in cirrhotic patients may be more severe and less frequently associated with chronic intake of non-steroidal anti-inflammatory drugs, and may require more frequently endoscopic treatment. Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. Patients with portal hypertension may experience bleeding from the stomach, and pharmacologic or radiologic interventional procedure may be useful in preventing re-bleeding from PHG. Gastric antral vascular ectasia (GAVE) seems to be different disease entity from PHG, and endoscopic ablation can be the first-line treatment.
肝硬化相关发病率和死亡率的一个主要原因是静脉曲张出血的发展，这是门静脉高压的直接后果。胃肠道出血的不常见原因包括消化性溃疡、恶性肿瘤、血管发育不良等。上消化道出血根据是否存在静脉曲张或非静脉曲张出血进行分类。虽然非静脉曲张性胃肠道出血在肝硬化患者中并不常见，但胃十二指肠溃疡的发生频率可能与非肝硬化患者相同。肝硬化患者的溃疡可能更严重，且不太常与长期服用非甾体抗炎药有关，可能需要更频繁地进行内镜治疗。门静脉高压性胃病 (PHG) 是指门静脉高压患者胃黏膜的变化。门静脉高压患者可能会出现胃部出血，药物或放射介入治疗可能有助于预防 PHG 再次出血。胃底静脉曲张（GAVE）似乎与 PHG 是不同的疾病实体，内镜消融术可以作为一线治疗方法。
