A 56-year-old man was admitted to our hospital for follow up endotherapy for esophageal varices. The scope revealed esophageal varices and severe portal gastropathy, especially in the fundus of the stomach.
Portal hypertensive gastropathy(PHG)#: changes in the mucosa of the stomach in patients with portal hypertension; by far the most common cause of this is cirrhosis of the liver.
These changes in the mucosa include friability of the mucosa and the presence of ectatic blood vessels at the surface. Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; On the endoscopic evaluation of the stomach, this condition shows a unique mosaic or "snake-skin" appearance to the mucosa of the stomach. The New Italian Endoscopic Club has classified the severity of PHG based on the presence of four primary lesions: mosaic-like pattern, redpoint lesions, cherry red spots, and black-brown spots. In mild PHG the gastric mucosa often looks reddened and oedematous with a snakeskin or mosaic pattern. The term scarletina has also been used to describe the early changes of PHG. Severe PHG#is defined by cherry red spots which are typically very friable and can actively bleed during endoscopy. In PHG, changes in the gastric mucosa are usually localized to the fundus or corpus of the stomach, but PHG-like conditions have been described elsewhere in the gastrointestinal tract, including the rectum, colon, and small bowel.
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