Gostout C J, Viggiano T R, Balm R K
Mayo Clinic, Rochester, Minnesota.
Am J Gastroenterol. 1993 Dec;88(12):2030-3.
The clinical and endoscopic features of patients diagnosed with acute bleeding due to portal hypertensive gastropathy (PHG) were evaluated. Acute bleeding from PHG was diagnosed in 12 patients (0.8%) of 1496 patient admissions prospectively evaluated by our Gastrointestinal Bleeding Team over a 3-yr period, and accounted for 8% of nonvariceal bleeding diagnosed in patients with liver disease. The median age of PHG patients (8M:4F) was 66 yr (range, 37-72). The most common underlying liver disease was alcoholic cirrhosis (five patients). The majority of patients presented with melena. There was no hemodynamic instability. Six patients had prior sclerotherapy. Esophageal varices, grades 1 (five patients) and 2 (three patients), were present. Severe PHG was encountered in seven patients. There was no correlation between the presence or absence of varices, the grade of esophageal varices, and prior sclerotherapy on the severity of PHG or continued bleeding. The mean hospital stay was 6 days. An average of 4 units of blood was transfused per patient (range, 2-8). Continued bleeding occurred in nine patients (75%), one of whom had mild PHG. Two patients with continued bleeding subsequently were diagnosed with portal hypertensive vasculopathy distal to the stomach. There was one episode of encephalopathy and no related mortality. Acute (overt) bleeding from PHG is uncommon, likely to recur, and can evolve into a pattern of chronic blood loss.
对诊断为门静脉高压性胃病（PHG）所致急性出血的患者的临床和内镜特征进行了评估。在我们的胃肠道出血团队对1496例患者入院情况进行前瞻性评估的3年期间，有12例患者（0.8%）被诊断为PHG急性出血，占肝病患者非静脉曲张性出血诊断病例的8%。PHG患者的年龄中位数为66岁（8例男性：4例女性）（范围为37 - 72岁）。最常见的基础肝病是酒精性肝硬化（5例患者）。大多数患者表现为黑便。无血流动力学不稳定情况。6例患者曾接受硬化治疗。存在1级（5例患者）和2级（3例患者）食管静脉曲张。7例患者出现严重PHG。静脉曲张的有无、食管静脉曲张的分级以及既往硬化治疗与PHG的严重程度或持续出血之间均无相关性。平均住院时间为6天。每位患者平均输血4单位（范围为2 - 8单位）。9例患者（75%）持续出血，其中1例为轻度PHG。2例持续出血的患者随后被诊断为胃远端门静脉高压性血管病。发生1次肝性脑病发作，无相关死亡病例。PHG急性（显性）出血并不常见，可能会复发，并可演变为慢性失血模式。
