Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis

Patrick S. Kamath, Marco Lacerda, David A. Ahlquist, Michael A. McKusick, James C. Andrews, David A. Nagorney

Research output: Contribution to journalArticle

140 Scopus citations

Abstract

Background and Aims: The response of gastric mucosal lesions in cirrhotic patients with portal hypertension, namely, portal hypertensive gastropathy (PHG) and gastric vascular ectasia (GVE), to transjugular intrahepatic portosystemic shunts (TIPS) is not known. Methods: Clinical and laboratory evaluation, upper gastrointestinal endoscopy, and Doppler ultrasonography were performed before placement of TIPS and 6 weeks, 3 months, and 6 months after TIPS in 54 patients. Thirty patients had mild PHG, 10 had severe PHG, and 14 had GVE. Results: Approximately 75% of the patients with severe PHG responded to TIPS as shown by improvement in endoscopic findings and by a decrease in transfusion requirements; 89% of patients with mild PHG had endoscopic resolution. Patients with GVE had neither endoscopic resolution nor a decrease in transfusion requirements after TIPS. There was no difference in mortality between the 2 groups. Conclusions: The results support the position that severe PHG and GVE may be different lesions. Mild and severe PHG respond to TIPS. Because GVE does not respond to TIPS, we recommend that TIPS be avoided for the treatment of gastrointestinal bleeding associated with GVE.

Original languageEnglish (US)
Pages (from-to)905-911
Number of pages7
JournalGastroenterology
Volume118
Issue number5
DOIs
StatePublished - Jan 1 2000

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Kamath, P. S., Lacerda, M., Ahlquist, D. A., McKusick, M. A., Andrews, J. C., & Nagorney, D. A. (2000). Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology, 118(5), 905-911. https://doi.org/10.1016/S0016-5085(00)70176-4