From the Guidelines
The treatment for portal hypertensive gastropathy (PHG) primarily focuses on reducing portal pressure and managing bleeding complications, with non-selective beta-blockers such as propranolol being a key component of therapy, as evidenced by recent studies 1. The management of PHG involves a multi-faceted approach, including:
- Reducing portal pressure through the use of non-selective beta-blockers, such as propranolol, which has been shown to improve outcomes in patients with PHG 1
- Addressing the underlying cause of portal hypertension, typically liver cirrhosis, through measures such as alcohol abstinence, viral hepatitis treatment, or weight loss in fatty liver disease
- Iron supplementation to address anemia from chronic blood loss, which can be oral or intravenous, depending on the severity of iron depletion 1
- Regular endoscopic surveillance to monitor disease progression and response to therapy In cases of acute bleeding, intravenous vasopressin analogues like terlipressin or octreotide can be used to reduce splanchnic blood flow, while transjugular intrahepatic portosystemic shunt (TIPS) procedure may be considered for refractory bleeding 1. Key considerations in the management of PHG include:
- The importance of reducing portal pressure to prevent bleeding complications
- The need for individualized treatment approaches, taking into account the underlying cause of portal hypertension and the presence of other comorbidities
- The role of iron supplementation in addressing anemia and improving quality of life
- The importance of regular monitoring and follow-up to adjust treatment as needed and prevent complications.
From the Research
Treatment Options for Portal Hypertensive Gastropathy
The treatment for portal hypertensive gastropathy (PHG) primarily focuses on reducing portal pressure and managing bleeding episodes. The following are some of the treatment options:
- Pharmacological therapies: Non-selective beta-blockers, such as propranolol, are commonly used to reduce portal pressure and gastric blood flow 2, 3, 4, 5.
- Endoscopic treatment: Endoscopic treatment plays a small role in the treatment of PHG, but it may be used to manage acute bleeding episodes 2.
- Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery: These procedures can help reduce portal pressure and lessen the severity of PHG, but they are typically reserved for cases where pharmacological therapy is ineffective or bleeding is severe 2, 4, 5.
- Iron supplementation: Iron supplementation is often used in conjunction with beta-blockers to manage chronic blood loss and anemia 4.
Management of Acute and Chronic Bleeding
The management of acute and chronic bleeding in PHG involves:
- Non-selective beta-blockers: These are used as first-line therapy for chronic bleeding and as secondary prophylaxis to prevent rebleeding 2, 4, 5.
- Vasoactive drugs: Somatostatin or its analogues, such as terlipressin, may be used to manage acute bleeding episodes 4.
- Shunt therapy: TIPS or shunt surgery may be considered in cases where bleeding is severe or unresponsive to pharmacological therapy 2, 4, 5.
Secondary Prophylaxis
Secondary prophylaxis with non-selective beta-blockers is recommended to prevent rebleeding in patients with PHG 2. However, there is limited evidence to support the use of beta-blockers in primary prophylaxis, even in cases of severe PHG 2.