Portal hypertensive gastropathy (PHG) has been recognised as an increasingly important source of bleeding in cirrhotic patients in whom an esophageal source of hemorrhage has been excluded [1]. Results of treatment of this condition have been disapointing [2]
[3]. Although some authors consider that PHG and gastric antral vascular ectasia (GAVE) represent two separate entities, a large overlap exists [4]. The use of corticosteroids has been reported to be successful in patients with GAVE [5]. On this basis, our group used oral corticosteroid therapy to treat a patient with severe PHG, who had shown no improvement from treatment with nonselective beta-blockers.
A 64-year-old man with alcoholic cirrhosis was admitted for the fifth time in a 5-month period for severe anemia (Hgb, 6.1 g/dl; serum iron, 10 µg/dl), without overt gastrointestinal bleeding. An upper gastrointestinal endoscopy showed grade II esophageal varices and severe PHG of the whole stomach, which was bleeding spontaneously (Figure [1]). Antrum biopsies showed vascular ectasia without inflammatory cells and no fibromuscular hyperplasia of the lamina propria. The patient was given 2 units of packed blood cells, and treatment with oral prednisolone 20 mg/day and with oral iron was started. The patient was discharged with a regimen of 20 mg of prednisolone on alternate days. At 2 months later the hemoglobin level had risen to 10.8 g/dl, and 4 months later an upper gastrointestinal endoscopic examination showed improvement in the PHG (Figure [2]). The prednisolone dose was reduced to 15 mg on alternate days and oral iron was stopped. After 15 months, there was no evidence of gastrointestinal bleeding or anemia and the prednisolone was stopped. A third upper gastrointestinal examination showed marked improvement in the PHG (Figure [3]). Over a 3-year follow-up period there was no recurrence of anemia and the cirrhosis remained stable.
Figure 1 Severe portal hypertensive gastropathy before treatment with corticosteroids
Figure 2 Improvement in severe portal hypertensive gastropathy after 4 months of corticosteroid treatment
Figure 3 Marked improvement in severe portal hypertensive gastropathy after 15 months of corticosteroid treatment
This report seems to show the efficacy of corticosteroids in the treatment of this group of patients; however the use of this medication needs to be further evaluated in controlled studies.
