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Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the ...
Gastric varices are dilated submucosal veins in the lining of the stomach, which can be a life-threatening cause of bleeding in the upper gastrointestinal tract.They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis.
The endoscopic appearance of GAVE is similar to portal hypertensive gastropathy, but is not the same condition, and may be concurrent with cirrhosis of the liver. [2] [6] [15] [16] 30% of all patients have cirrhosis associated with GAVE. [6] Sjögren's syndrome has been associated with at least one patient. [17]
Medications typically includes octreotide or if not available vasopressin and nitroglycerin to reduce portal pressures. [21] This is typically in addition to endoscopic banding or sclerotherapy for the varices. [21] If this is sufficient then beta blockers and nitrates may be used for the prevention of re-bleeding. [21]
Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. [3] [4] Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. [5]
The term gastropathy means "stomach disease" and is included in the name of the diseases portal hypertensive gastropathy, hyperplastic hypersecretory gastropathy (Ménétrier's disease), and others. However, not all stomach diseases are labeled with the word "gastropathy"; examples include peptic ulcer disease, gastroparesis, and dyspepsia.
This is in addition to endoscopic banding or sclerotherapy for the varices. [13] If this is sufficient then beta blockers and nitrates may be used for the prevention of re-bleeding. [13] If bleeding continues, balloon tamponade with a Sengstaken-Blakemore tube or Minnesota tube may be used in an attempt to mechanically compress the varices. [13]
Portal hypertension is often present, and this may lead to the development of prominent veins in many parts of the body, such as oesophageal varices, and haemorrhoids. [ 5 ] : 959–963, 971–973