Portal hypertensive gastropathy: Prevalence and factors associated with its severity

Aims Portal hypertensive gastropathy (PHG) is often underestimated in clinical practice in cirrhotic patients, as attention is mainly paid to the search and treatment of esophageal (OE) and gastric varices. PHG is rarely responsible for upper gastrointestinal bleeding (UGB), which explains why few studies have focused on it. Its relationship with OE and the severity of cirrhosis is controversial. The aim of the study is to specify the frequency of gastropathy and to determine its relationship with the clinical, biological and endoscopic characteristics of cirrhosis.

Methods We conducted a descriptive and analytical cross-sectional study in the Gastroenterology I department of the Mohamed V Military Hospital; involving 102 cirrhotic patients; over a period of 3 years from January 2021 to January 2024. All patients underwent an esophagogastroduodenal fibroscopy. The severity of GHP was referenced according to the NIEC classification. The severity of cirrhosis was stratified according to CHILD, MELD score, albumin and bilirubin. The data were analyzed by JAMOVI for in-depth analysis.

Results The study included 102 cirrhotic patients, the median age was 62 years [55 – 73.8], with a sex ratio M/F at 1.9. The etiology of cirrhosis was dominated by viral hepatitis C in 22%, viral hepatitis B in 16%, while the undetermined origin was 32%. Cirrhosis was classified as Child Pugh A in 34% of cases, Child Pugh B in 36% of cases and Child Pugh C in 30% of cases.Hypertensive gastropathy was observed in 76.6%: mild (21.3%), moderate (40.4%) and severe in 14.9% of cases. VO was present in 95.7% of which 14.9% were grade 1, 46.8% were grade 2 and 53.20% were grade 3.In the group of patients with grade 1 VO, GHP was mild in 71.4%, moderate in 28.6%, and no patient had severe gastropathy. On the other hand, in patients with grade 3 VO, GHP was mild in 8%, moderate in 28% and severe in 44%.In addition, there were no significant differences in Child Pugh (p=0.612), MELD score (p=0.598), bilirubin (p=0.686) and ALT (p=0.311) between the group with mild GHP and severe GHP.In univariate analysis, factors significantly associated with the presence of moderate to severe GHP were: large VO, hypoalbuminemia (< 35 g/l) and low platelet count (< 100000mm3).The p value was 0.006, 0.020 and 0.050 respectively.In multivariate analysis,adjusting for the above factors, VO grades, thrombocytopenia, and hypoalbuminemia were independently associated with the severity of GHP. (p<0.001)

Conclusions In our study, the frequency of GHP was 76.6%. The severity of GHP was significantly associated with the grade of VO, platelet count and albumin level. In addition, no association was found with Child Pugh, MELD score, bilirubin and ALT.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025