Cirrhosis Associated Congestive Gastropathy

Physiopathological aspects
  • R. Petrino
  • A. Di Napoli
  • S. Avignone
  • M. Mestriner
  • C. Marinone
  • L. Chiandussi

Summary

Cirrhosis associated congestive gastropathy (CG) is an endoscopic and histological condition located in gastric mucosa, characterized mainly by vascular alterations. While the endoscopic picture, although well classified by Mc Kormack description, is not specific, the histological findings are typical, and comprehend initially inflammatory lesions, and in more advanced stages microvascular lesions. The supposed pathogenesis of such alterations is a deregulated release of vasoactive substances, with prevalence of vasodilators. The main factor implicated seems to be nytric oxyde (NO), overproducted by inducible NO-syntase, related to endotoxemia. In this study we have tried to better define the prevalence of vascular and inflammatory lesions in CG and to relate them to the pathogenetic process. We have considered the endoscopic and histologic observations in a cirrhotic population, grading each parameter in an attempt to find significant association. The results obtained show that both inflammatory and vascular lesions are present in about 80% of cases, and that also in 78% of patients there was a bacterial pollution that is significantly related to esophageal varices, vascular and inflammatory histological damage but not to endoscopic evidence of GC. We conclude that the possible pathogenic mechanism may start from blood stasis with vasodilatation, followed by bacterial pollution which causes mucosal damage and an inflammatory reaction.

Keywords

Gastric Mucosa Portal Hypertension Cirrhotic Patient Atrial Natriuretic Peptide Esophageal Varix 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Payen, J.L., Cales, P.: Modifications gastriques au cours de la cirrhose, Gastroenterol. Clin. Biol. 15 (1991), 285–295.PubMedGoogle Scholar
  2. 2.
    Vigneri, S., Termini, R., Piraino, A., Scialabba, A., Pisciotta, G., Fontana, N.: The stomach in liver cirrhosis. Endoscopic morphological and clinical correlations, Gastroenterology 101 (1991), 472–478.PubMedGoogle Scholar
  3. 3.
    Lingenfelser, T., Krige, J.E.: The stomach in cirrhosis. The legend of Proteus retold, J. Clin Gastroenterol 17 (1993), 92–96.PubMedCrossRefGoogle Scholar
  4. 4.
    Cales, P., Buscail, L., Bretagne, J.F., Champigneulle, B., Bourbon, P., Duclos, B., Dapoigny, M., Dumas, R., Pierrugues, R., Davion, T., Cenni, J.C., Pariente, E.A.: Concordance inter-observateurs inter-centres des signes endoscopiques gastro-esophagiens au cours de la cirrhose. Resultats d’une étude prospective multicentrique, Gastroenterol. Clin. Biol. 13 (1989), 967–973.PubMedGoogle Scholar
  5. 5.
    Cales, P., Zabotto, B., Meskens, C, Caucanas, J.P., Vinei, J.P., Desmorat, H., Fermanian, J., Pascal, J.P.: Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociation and relationship to hepatic dysfunction, Gastroenterology 98 (1990), 156–162.PubMedGoogle Scholar
  6. 6.
    Hashizume, M, Kitano, S., Hamaga, H., Koyanagi, N., Sugimachi, K.: Endoscopic classification of gastric varices, Gastrointest. Endosc. 36 (1990), 276–280.PubMedCrossRefGoogle Scholar
  7. 7.
    Misra, S.P., Dwivedi, M., Misra, V., Agarwal, S.K., Gupta, R., Gupta, S.C., Mital, V.P.: Endoscopic and histologic appearance of the gastric mucosa in patients with portal hypertension, Gastrointest. Endoscopy 36 (1990), 575–579.CrossRefGoogle Scholar
  8. 8.
    McCormack, T.T., Sims, J., Eyre-Brook, I., Kennedy, H., Goepel, J., Johnson, A.G., Triger, D.R.: Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy, Gut 26 (1985), 1226–1232.PubMedCrossRefGoogle Scholar
  9. 9.
    Di Napoli, A., Petrino, R., Boero, M., Bellis, D., Chiandussi, L.: Quantitative assessment of histological changes in chronic gastritis after eradication of Helicobacter pylori, J. Clin Pathology 45 (1992), 796–798.CrossRefGoogle Scholar
  10. 10.
    Papazian, A., Braillon, A., Dupas, J.L., Sevenet, F., Capron, J.P.: Portal hypertensive gastric mucosa: an endoscopic study. Gut 27 (1986), 1199–1203.PubMedCrossRefGoogle Scholar
  11. 11.
    Phelps, T.O., Mullone, J.: Portal hypertension and gastric erosions in the rat. Arch. Surg. 111 (1976), 190–194.PubMedGoogle Scholar
  12. 12.
    Iwao, T., Toyonaga, A., Sumino, M., Takagi, K., Oho, K., Nishizono, M., Ohkubo, K., Inoue, R., Sasaki, E., Tanikawa, K.: Portal hypertensive gastropathy in patients with cirrhosis, Gastroenterology 102 (1992), 2060–2065.PubMedGoogle Scholar
  13. 13.
    Gianelli, C., Gioineni, A., Graziani, M.G., Luminari, M.: Gastric damage in cirrhotic patients: endoscopic and histological findings, Gastroenterology 96 (1989), 600.Google Scholar
  14. 14.
    McCormick, P.A., Sakey, E.A., Dhillon, A.P., Kaye, G., Mclntyre, N., Burroughs, A.K.: Portal hypertensive gastropathy or Campylobacter pylori associated gastritis, J. Hepatology 9 (1989), 563.CrossRefGoogle Scholar
  15. 15.
    Benoit, J.N., Womack, W.A., Korthuis, R.J., Wilborn, W.H., Granger, D.N.: Chronic portal hypertension effects on gastrointestinal blood flow distribution, Am. J. Physiology 250 (1986), 535–539.Google Scholar
  16. 16.
    Gerahty, J.G., Angersin, W.S., Carter, D.C.: Autoradiographic study of the regional distribution of gastric blood flow in portal hypertensive rats, Gastroenterology 97 (1989), 1108–1114.Google Scholar
  17. 17.
    Leung, F.U., Slodownik, E., Jensen, D.M., Vendeventer, G., Guth, P.H.: Gastroduodenal mucosal hemodynamics by endoscopic reflectance spectrometry, Gastrointest. Endoscopy 37 (1987), 284–288.CrossRefGoogle Scholar
  18. 18.
    Moreau, R., Lee, S., Soupison, T., Roche Sicot, J., Sicot, C: Abnormal tissue oxygenation in patients with cirrhosis and liver failure, J. Hepatology 7 (1988), 98–105.CrossRefGoogle Scholar
  19. 19.
    Sarfeh, J., Tarnawaski, A.: Gastric mucosal vasculopathy in portal hypertension, Gastroenterology 93 (1987), 1129–1131.PubMedGoogle Scholar
  20. 20.
    Panes, J., Bordas, J.M., Pique, J.M., Bosch, J., Garcia-Pagan, J.C., Feu, F., Casadevall, M., Teres, J., Rodés, J.: Increased gastric mucosal perfusion in cirrhotic patients with PGH, Gastroenterology 103 (1992), 1875–1882.PubMedGoogle Scholar
  21. 21.
    Wu, Y., Cartland Burns, R., Sitzman, J.V.: Effects of Nitric Oxide and glocoxigenase inhibition of splanchnic hemodinamics in portal hypertension, Hepatology 18 (1993), 1416–1421.PubMedCrossRefGoogle Scholar
  22. 22.
    Guarner, C, Soriano, G., Tomas, A., Bulbena, O., Novella, M.T., Balanzo, J., Vilardell, F., Mourelle, M., Moncada, S.: Increased serum nitrate levels in patients with cirrhosis: relationship to endotoxemia, Hepatology 18 (1993), 1139–1143.PubMedCrossRefGoogle Scholar
  23. 23.
    Blei, A.T.: Portal hypertension, Current Opinion in Gastroenterology 10 (1994), 295–302.CrossRefGoogle Scholar
  24. 24.
    Vallance, P., Moncada, S.: Hyperdynamic circulation in cirrhosis: a role of nitric oxyde?, Lancet 337 (1991), 776–778.PubMedCrossRefGoogle Scholar
  25. 25.
    Pique, J.M., Esplugnes, J.V., Witthle, B.J.R.: Endogenous NO as a mediator of gastric mucosal vasodilatation during acid secretion, Gastroenterology 102 (1992), 168–174.PubMedGoogle Scholar
  26. 26.
    Whittle, B.J.R., Lopez-Belmonte, J., Moncada, S.: Regulation of gastric mucosal integrity by endogenous NO: interactions with prostanoids and sensory neuropeptides in the rat. Br. J. Pharmacology 99 (1990), 607–611.Google Scholar
  27. 27.
    Lopez-Talavera, J.C., Merrill, W.W., Groszmann, J.: Tumor necrosis factor alpha: a major contributor to the hyperdynamic circulation in prehepatic portal hypertensive rats. Gastroenterology 108 (1995), 761–767.PubMedCrossRefGoogle Scholar
  28. 28.
    Garcia-Tsao, G., Albillos, A., Barden, G.E., West, A.B.: Bacterial translocation in acute and chronic portal hypertension, Hepatology 17 (1993), 1081–1085.PubMedCrossRefGoogle Scholar
  29. 29.
    Sorell, W.T., Quigley, E.M.M., Jin, G., Johnson, T.J., Rikkers, L.F.: Bacterial translocation in the portal hypertensive rat: studies in basal conditions and on exposure to hemorragic shock, Gastroenterology 104 (1993), 1722–1726.PubMedGoogle Scholar
  30. 30.
    Genecin, P., Groszman, P.J.: Portal hypertension. Disease of the Liver 7th ed. Shiff, E., Shiff, L. Eds. Lippincott, Philadelphia 1993, 935–973.Google Scholar
  31. 31.
    D’Amico, G., Montalbano, L., Traina, M., Pisa, R., Menozzi, M., Spanö, C, Pagliaro, L., and The Liver Study Group of V. Cervello Hospital: Natural history of congestive gastropathy in cirrhosis, Gastroenterology 99 (1990), 1558–1564.PubMedGoogle Scholar
  32. 32.
    Guslandi, M., Sorghi, M., Foppa, L., Tittobello, A.: Congestive gastropathy versus chronic gastritis: a comparison of same pathophysiological aspects, Digestion 54 (1993), 160–162.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • R. Petrino
    • 1
  • A. Di Napoli
    • 1
  • S. Avignone
    • 1
  • M. Mestriner
    • 1
  • C. Marinone
    • 1
  • L. Chiandussi
    • 1
  1. 1.Division of Internal MedicineUniversity of Turin. S. Vito HospitalTurinItaly

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