Skip to main content

Advertisement

SpringerLink
Log in

Gastric red spots in patients with cirrhosis: Subclinical condition of gastric mucosal hemorrhage?

  • Alimentary Tract
  • Published:
Gastroenterologia Japonica Aims and scope Submit manuscript

Summary

The present study was intended to assess the incidence and the nature of gastric red spots (GRS) in patients with liver cirrhosis. Endoscopically, GRS was more frequently observed in patients with cirrhosis (n = 146) than those without cirrhosis (n = 103) (43.2% vs. 4.8%; P< 0.001). There was no relationship between the incidence of GRS and the severity of cirrhosis or the size of varices. Portal venous pressure was higher in cirrhotics with GRS (n=21) than those without GRS (n=25) (33.7±6.0 mmHg vs. 28.2±4.8 mmHg; P<0.001). Morphometric analysis using the biopsied specimens was made in 16 cirrhotics with GRS, 12 cirrhotics without GRS, and 15 non-cirrhotics. The capillary bed occupation ratio (vascular area/mucosal area) was higher in cirrhotics with GRS (9.3±4.0%) than those without GRS 84.1 ±1.1%) or the non-cirrhotics (3.4±9.8%) (P< 0.005, P< 0.005), while there was no significant differences in the number of capillaries per unit area. Infiltrating inflammatory cell count was similar among the three groups. Extravascular red blood cell count per unit area was higher in cirrhotics with GRS (29.7±31.4) than those without GRS (5.4±5.1) or non-cirrhotics (5.4±6.3) (P< 0.05, P< 0.01). Furthermore, extravasation of red blood cells through defective portion of the endothelium and interposition of red blood cells in interepithelial spaces were observed electron microscopically in cirrhotics with GRS. These results indicate that (a) the nature of GRS in cirrhotics is preexistential capillary ectasia with intramucosal hemorrhage which is caused by high portal pressure and (b) the GRS in cirrhotics might be a subclinical condition of gastric mucosal hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Merrigan CT, Hollister MR, Gryska, et al: Gastrointestinal bleeding with cirrhosis. N Engl J Med 1960;12:579–585

    Article  Google Scholar 

  2. McCray SR, Martin F, Amir-Ahmadi H, et al: Errouneous diagnosis of hemorrhage from esophageal varices. Digest Dis 1969;14:755–760

    Article  CAS  Google Scholar 

  3. Khodadoost J, Glass JBG: Erosive gastritis and acute gastroduodenal ulcerations as source of upper gastrointestinal bleeding in liver cirrhosis. Digestion 1972;7:129–138

    Article  PubMed  CAS  Google Scholar 

  4. Waldram R, Davis M, Nunnerrley H, et al: Emergency endoscopy after gastrointestinal hemorrhage in 50 patients with portal hypertension. Br Med J 1974;12:94–97

    Google Scholar 

  5. Teres J, Bordas JM, Bru C, et al: Upper gastrointestinal bleeding in cirrhosis: Clinical and endoscopic correlation. Gut 1976; 17:37–40

    Article  PubMed  CAS  Google Scholar 

  6. Franco D, Deporte A, Durandy Y, et al: Upper gastrointestinal hemorrhage in cirrhosis. Lancet 1977;l:218–220

    Article  Google Scholar 

  7. Labrec D, Fleury DP, Rueff B: Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 1980;79:1139–1144 692

    Google Scholar 

  8. Sarfeh JI, Tabak C, Eugene J, et al: Clinical significance of erosive gastritis in patients with alcoholic liver disease and upper gastrointestinal hemorrhage. Ann Surg 1981;194:149–151

    Article  PubMed  CAS  Google Scholar 

  9. Iwao T, Toyonaga A, Tanaka J, et al: Endoscopic and clinical study on hemorrhagic gastritis in patients with liver cirrhosis. Digest Endoscopy 1990;2:28–39 (in press)

    Article  Google Scholar 

  10. Kamata T, Kobayashi K, Hatakeyama M: The source of gastrointestinal bleeding in autopsied cases with chronic hepatic disease (abstract). Jpn J Gastroenterol 1978;75:323 (in Japanese)

    Google Scholar 

  11. Enquist IF, & Gliedman ML: Sources of upper gastrointestinal bleeding in patients with cirrhosis. Surg Gyne & Obst 1958;106:153–158

    CAS  Google Scholar 

  12. McCormack TT, Sims J, Eyre-Brook I, et al: Gastric lesions in portal hypertension: inflammatory or congestive gastropathy? Gut 1985;26:1226–1232

    Article  PubMed  CAS  Google Scholar 

  13. Papazian A, Brallion A, Dupas LJ, et al: Portal hypertensive gastric mucosa: an endoscopie study. Gut 1986;27:1199–1203

    Article  PubMed  CAS  Google Scholar 

  14. Shimotsuura Y, Toyonaga A: Correlative studies on endoscopie findings and hemodynamics of the gastric mucosa in patients with cirrhosis (abstract). Gastroent Endoscopy 1986:28:1134–1135

    Google Scholar 

  15. Adachi H: The study of gastric mucosal changes and it’s mechanism in patients with liver cirrhosis (abstract). Gastroent Endoscopy 1987:29:455–471

    Google Scholar 

  16. Pugh HN, Murray-Lyon MI, Dawson LJ, et al: Transection of oesophagus for bleeding oesophageal varices. Br J Surg 1973;60: 646–649

    Article  PubMed  CAS  Google Scholar 

  17. Japanese Research Society for Portal Hypertension: The general rules for recording endoscopie findings on esophageal varices. Jap J Surg 1980;10:84–87

    Article  Google Scholar 

  18. Okuda K, Suzuki K, Musha H, et al: Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. A preliminary report. Gastroenterology 1977;73:279–284

    PubMed  CAS  Google Scholar 

  19. Rector WG, Reynolds TB: Risk factors for hemorrhage from esophageal varices and acute gastric ersions. Clinics in Gastroenterology 1985:14:139–153

    PubMed  Google Scholar 

  20. Sarfeh JI, Tarnawski A, Malki A, et al: Portal hypertension and gastric mucosal injury in rats. Gastroenterology 1983;84:987–993

    PubMed  CAS  Google Scholar 

  21. Lebrec D, Poynard T, Hillon P, et al: Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study. N EngI J Med 1981:305:1371–1374

    Article  CAS  Google Scholar 

  22. Lebrec D, Poynard T, Bercoff E, et al: A randomized controlled study of recurrent gastrointestinal bleeding in patients with cirrhosis: final report. Hepatology 1984;4:355–358

    PubMed  CAS  Google Scholar 

  23. Quintero E, Pique MJ, Bombi AJ, et al: Gastric mucosal vascular ectasias causing bleeding in cirrhosis. Gastroenterology 1987:93:1054–1061

    PubMed  CAS  Google Scholar 

  24. Hashizume M, Tanaka K, Inokuchi K: Morphology of gastric microcirculation in cirrhosis. Hepatology 1983:3:1008–1012

    Article  PubMed  CAS  Google Scholar 

  25. Manabe T, Suzuki T, Honjo I: Changes of gastric blood flow in experimentally induced cirrhosis of the liver. Surg Gyne & Obst 1978:17:753–757

    Google Scholar 

  26. Hidaka R: The gastric mucosal blood flow in patient with liver cirrhosis: Special reference to the endoscopie injection sclero therapy and gastric mucosal lesions (abstract). Gastroent Endoscopy 1985:27:1739

    Google Scholar 

  27. Fukuda M, Kawano S, Sato N, et al: Gastric mucosal hemodynamics and oxygen sufficiency in patients with liver cirrhosis assesses by reflectance spectrophotometry (abstract). Jpn J Gastroenterol 1986:83:32 (in Japanese)

    Google Scholar 

  28. Scobie BA, Sumemerskill WHJ: Reduced gastric acid output in cirrhosis: Wuantitation and relationships. Gut 1954;5:422–428

    Article  Google Scholar 

  29. Schmidt HA, Martini GA: Gastric secretion in chronic liver disease. German Medical Monthly 1969:14:246–254

    PubMed  Google Scholar 

  30. Lam KS: Hypergastrinemia in cirrhosis of liver. Gut 1976;17: 700–708

    Google Scholar 

  31. Sarfeh IJ, Tarnawski A: Functional, histologic and ultrastructural characteristics of the portal hypertensive gastric mucosa. J Gastroenterol Hepatol 1984:4(Suppl l):1–7

    Google Scholar 

  32. Kato K: Endoscopie and histological study of gastric mucosa in liver cirrhosis: With special reference to cases treated with endoscopie injection sclerotherapy for esophageal varices (abstract). Gastroent Endoscopy 1987;29:2166–2176

    Google Scholar 

  33. Fawcett WD: A textbook of histology. Blood and lymphovascular system. 11th Ed, Saundcrs WB company, Philadelphia. 1986:381–391

    Google Scholar 

  34. Tanawski A, Sarfeh IJ, Stachura J, et al: Portal hypertensive gastropathy or vasculopathy? Gastroenterology 1987;92:1786

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Second Department of Medicine, Kurume University School of Medicine, 67 AsahiMachi, 830, Kurume, Japan

    Tadashi Iwao M.D., Atsushi Toyonaga & Kyuichi Tanikawa

Authors
  1. Tadashi Iwao M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Toyonaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyuichi Tanikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iwao, T., Toyonaga, A. & Tanikawa, K. Gastric red spots in patients with cirrhosis: Subclinical condition of gastric mucosal hemorrhage?. Gastroenterol Jpn 25, 685–692 (1990). https://doi.org/10.1007/BF02779181

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02779181

Key words

Search

Navigation