Table 10.
Differences in gastrointestinal bleeding from portal hypertensive gastropathy vs esophageal varices
| Parameter | Portal hypertensive gastropathy | Esophageal varices |
| Etiology | Portal hypertension: Cirrhotic or non-cirrhotic | Portal hypertension: Cirrhotic or non-cirrhotic |
| Concurrence | Frequently occur simultaneously with esophageal varices because the two diseases share common risk factors | Frequently occurs simultaneously with PHG because the two diseases have common risk factors |
| Location | Stomach: Predominantly fundus and body | Distal esophagus: Also can have gastric varices or ectopic varices in other gastrointestinal regions, particularly duodenum |
| Diagnosis | Esophagogastroduodenoscopy | Esophagogastroduodenoscopy |
| Endoscopic appearance | Erythematous small polygonal areas of mucosa surrounded by a fine, whitish, reticular or mosaic/snakeskin mucosa with red or brown spots | Serpiginous mucosal greyish luminal projections in distal esophagus |
| Clinical presentation | Mild acute or chronic bleeding | Acute gastrointestinal bleeding-typically massive |
| Severity of bleeding | Typically mild and not life-threatening | Typically severe and life-threatening |
| Histology | Not biopsied at endoscopy | |
| Endoscopic therapy | Limited role | Variceal ligation recommended as initial therapy. Sclerotherapy an alternative therapy |
| Medical therapy | Octreotide | Octreotide |
| Propranolol | Propranolol | |
| Vasopressin or vasopressin analogues-infrequently recommended any more | Vasopressin or vasopressin analogues-infrequently recommended any more | |
| Blakemore tube | Not recommended | Sometimes used for refractory bleeding especially as a temporizing measure before performing more definitive therapy |
| Angiographic therapy | TIPS used as a last resort | TIPS recommended if endoscopic therapy fails |
| Transfusion of packed erythrocytes | Transfuse only to hematocrit of about 28. Over-transfusion may increase portal pressure and induce greater bleeding | Transfuse only to hematocrit of about 28. Over-transfusion may increase portal pressure and induce greater bleeding |
| Liver transplantation | Improves or resolves with liver transplantation | Improves or resolves with liver transplantation |
| Prognosis | Rarely fatal | Frequently fatal |
TIPS: Transjugular intrahepatic portosystemic shunt; PHG: Portal hypertensive gastropathy.