Congestive Gastropathy and Antral Varices: Is there an Association?

Summary

Gastric mucosal lesions are frequently observed during endoscopy in cirrhotics, but only recently has attention been paid to the gastric mucosal vessels themselves as the cause of such lesions. The presence - observed during endoscopy - of areas of erythema outlined by a yellow mosaic-like network, and the existence - ascertained by histology - of focal ectasia of mucosal vessels are termed “congestive gastropathy”.

In a prospective investigation of this entity, gastric mucosal biopsies have been obtained in 20 portal hypertensive patients with or without signs of congestive gastropathy at their initial sclerotherapy session. During the progress of the study two - Child's C - patients (having negative endoscopic and microscopic findings of congestive gastropathy) exhibited severe lesions of congestive gastropathy at the 2nd and 3rd session, respectively, and further biopsies were therefore obtained. Histologic examination after eosin-hematoxylin and Masson's trichrome staining revealed dilated mucosal vessels. At the 3rd and the 5th sclerotherapy session, respectively, - their esophageal varices having been obliterated - antral varices were prominent.

We ascribe the endoscopic changes observed in the gastric mucosa to the alteration of gastric vascularity due to blood flow redistribution, but we pose the question as to whether there is any association between these progressive mucosal alterations and the formation of antral varices.

Key words:

Portal hypertension - Endoscopic sclerotherapy - Congestive gastropathy - Antral varices