Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis.

Shahid Ahmed, Aga Khan University
Khalid Mumtaz, Aga Khan University
Umair Syed Ahmed, Aga Khan University
Syed H Shah, Agha Khan University
Shahab Abid, Aga Khan University
Saeed Hamid, Aga Khan University
Wasim Jafri, Aga Khan University


Objective: To determine the frequency and specific characteristic features of portal hypertensive gastropathy (PHG) in cirrhosis due to viral etiology.

Study Design: Cross-sectional descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from June 2006 till June 2008.

Methodology: Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastroduodenoscopy (EGD) for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh (CTP) score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test.

Results: Out of 360 patients who underwent screening EGD, 226 (62.8%) were males. Two hundred and eighty one (78%) had hepatitis C while 79 (22%) suffered from hepatitis B related cirrhosis. Three hundred patients (83.3%) had PHG while 71 (24%) had severe PHG. Higher proportion of esophageal varices (89.7%) was present among those who had PHG (p < 0.001). On univariate analysis lower platelet counts (117±55 vs. 167±90; p < 0.001), increased spleen size (14.1±2.9 cm vs. 12±2.4cm; p < 0.001) were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG (916±400 vs. 1477±899; p < 0.001). Furthermore, on multivariate analysis CTP score > 8 MELD score > 12 and platelets/spleen ratio < 900 were significantly associated factors with severe PHG.

Conclusion: Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score > 12, CTP score ≥ 8 and platelets/spleen ratio < 900 were significant factors of severe PHG