Portal hypertensive gastropathy.

PHG is a common condition that is now recognized as a complication of advanced liver disease. This vascular disorder has been shown to be a significant cause of upper gastrointestinal bleeding in patients with portal hypertension. Although its pathogenesis is directly related to portal hypertension, the exact mechanisms remain to be determined. Decreased mucosal blood flow and passive congestion of the gastric submucosal layer appear to play a role in the development of PHG. Its endoscopic appearance is characterized by a "snake skin" mucosal pattern with gastric biopsies revealing vascular congestion. PHG may present as either acute or chronic gastrointestinal bleeding and has been noted to worsen after endoscopic sclerotherapy and band ligation therapy for esophageal varices. Unlike variceal bleeding, this condition cannot be treated with either sclerotherapy or band ligation. Effective treatment requires a reduction in portal pressure. This can be accomplished through the use of beta-blockers, radiographic or surgical shunting, or liver transplantation.