Histopathological study of portal hypertensive gastropathy using gastric biopsy

Background and Objectives: Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. The diagnosis of PHG is usually made on endoscopy. It is clinically important because it may cause acute massive or insidious blood loss. We present a comprehensive study to ascertain the utility of gastric biopsy in identifying and assessing the presence and degree of pathological changes associated with PHG. Materials and Methods: Histological features of 30 gastric biopsies each from antrum and body of patients of portal hypertension with or without gastric symptoms were studied. They were grouped as Group A patients. Similarly, the histological features of 30 gastric biopsies each from antrum and body of patients of gastritis without portal hypertension were studied and were grouped as Group B patients. The biopsies were studied for mucosal changes such as edema in lamina propria, degree of inflammation, smooth muscle hyperplasia, collagen deposition, foveolar hyperplasia, intestinal metaplasia, presence of Helicobacter pylori, and fibrin thrombi. Results: Most common cause of portal hypertensive gastropathy was alcoholic liver cirrhosis. Histological features such as dilated congested capillaries, edema, extravasated red blood cell (RBC), and smooth muscle hyperplasia are more commonly seen in PHG (Group A) than gastritis (Group B) patients without portal hypertension. Conclusion: Alcoholic cirrhosis is a common cause of PHG. Dilated congested capillaries, edema, extravasated RBC, and smooth muscle hyperplasia are frequently seen in gastric biopsies of PHG patients than gastritis patients. These features are nonspecific.