Study of Upper Gastrointestinal Tract Endoscopic findings in Portal Hypertension

Buddha Bahadur Karki,Lochan Karki,Manen Prasad Gorkhaly

doi:10.31729/jnma.2113

Abstract

The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage. The mucosal changes in portal hypertension may require pharmacological, directed endoscopic or portal decompressive therapy. The objective of the study is to ﬁnd out various upper gastrointestinal tract endoscopic ﬁndings in patients of portal hypertension. A prospective, cross-sectional, observational study of sixty patients of portal hypertension was conducted from June to October 2009. The esophagus, stomach and upper duodenum was visualized for any changes, especially by taking the tip of the instrument close to the mucosa. Out of total, 60, 47 (78.3%) cases were cirrhotic and 13 (21.7%) cases were non-cirrhotic portal hypertension. The most frequent upper GI endoscopic ﬁnding was esophageal varices 56 (98.3%) followed by gastropathy 49 (81.6%), gastric hyperemia 19 (31.6%), duodenal hyperemia and erosive gastritis 16 (26.6% in each) and gastric varices 12 (20%). Esophageal varices were equally prevalent among cirrhotic and non cirrhotic portal hypertensive patients, 46 out of 47 (97.9%) and 13 out of 13 (100%) respectively. Gastropathy was more prevalent in cirrhotic patients with 87.2% vs. 75% in NCPF followed by 40% in EHO. However, duodenal ulcers were seen only in EHO 12.5%. Erosive gastritis was more prevalent in EHO (75%) followed by NCPF (60%), however, it was less frequent in cirrhotic portal hypertension (14.8%). The most common upper GI endoscopic ﬁnding in portal hypertensive patients were found to be esophageal varices followed by gastropathy, peptic ulcer disease (gastric and duodenal hyperemia, chronic gastritis, erosive gastritis, gastric ulcer and duodenal ulcer).

Highlights

The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage
Erosive gastritis was more prevalent in extra hepatic portal obstruction (EPO), six out of eight (75%) followed by three out of five (60%) in non cirrhotic portal fibrosis (NCPF), it was less frequent in cirrhotic portal hypertension seven out of 47 (14.8%) (Table 3)
Gastropathy was more prevalent in cirrhotic patients with 87.2% (41 out of 47) vs. 75% in NCPF followed by 40% in EPO

Summary

Introduction

The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage. Portal Hypertension is defined as a clinical syndrome manifested by hemodynamic changes due to difficult blood outflow from the portal bed.[1] The common causes of portal hypertension are cirrhosis of liver, non –cirrhotic portal fibrosis and extra hepatic portal vein obstruction due to umbilical sepsis. Karki et al Study of Upper Gastrointestinal Tract Endoscopic findings in Portal Hypertension from different non variceal lesion like portohypertensive gastroduodenopathy, gastroduodenal ulcer, Mallory Weiss tear, esophago-gastroduodenitis etc. These complementary processes of vasoreactivity and vascular remodeling contribute importantly to increased intra hepatic resistance and represent important targets in the treatment of portal hypertension.[3]

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