Short-Term Effects of Variceal Sclerotherapy on Portal Hypertensive Gastropathy

Abstract

Background and Study Aims: Obliteration of esophageal varices may modify the mucosal perfusion of the stomach. The relationship between short-term injection variceal sclerotherapy (IVS) and the evolution of portal hypertensive gastropathy (PHG) is insufficiently recognized.

Patients and Methods: Forty-one cirrhotic patients were treated with hemostatic or secondary preventive IVS. They underwent sclerotherapy at intervals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system assigning 0 points for a normal mucosal image, 1 point for reddened, 2 points for a mosaic-like mucosal pattern, and 3 points for a mosaic-like pattern plus red marks in the stomach. All patients received propranolol after the first sclerotherapy session.

Results: The total score before IVS was 45 points (1.1 points per patient). After 188 sclerotherapy sessions (2-8 per patient), the score significantly increased to 73 points (1.8 points per patient, P = 0.04). This effect was particularly marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P = 0.01), and negligible in patients with either less or more advanced cirrhosis (Child-Pugh classes A and C).

Conclusions: In patients with cirrhosis, short-term IVS may contribute to the mechanisms of progressive PHG.