Can Varices Develop Along the Entire Gastric Body?
Yes, varices can develop throughout the stomach, including the entire gastric body, though their distribution follows specific anatomical patterns based on the underlying venous drainage and type of portal hypertension.
Anatomical Distribution of Gastric Varices
Gastric varices are classified based on their location and relationship to esophageal varices 1:
- Gastroesophageal varices type 1 (GOV1): Extend from the esophagus along the lesser curvature of the stomach, which includes portions of the gastric body 1, 2
- Gastroesophageal varices type 2 (GOV2): Extend from the esophagus into the gastric fundus 1, 2
- Isolated gastric varices type 1 (IGV1): Located in the fundus without esophageal varices 1, 2
- Isolated gastric varices type 2 (IGV2): Can occur in any other gastric region, including the body, antrum, or even duodenum 1, 2
The key point is that IGV2 varices specifically can develop anywhere in the stomach beyond the fundus, meaning the entire gastric body is susceptible to variceal formation 1, 2.
Pathophysiology Supporting Body Involvement
The development of varices throughout the gastric body is explained by the extensive collateral venous network in portal hypertension 1:
- Collaterals form through intrinsic and extrinsic gastroesophageal veins 1
- Blood can be diverted through gastric, pancreatic, splenic, and short gastric veins 1
- The posterior gastric vein and gastric epiploic vein contribute to variceal formation along the body 1
Clinical Prevalence and Significance
Gastric varices occur in approximately 20% of patients with portal hypertension, with GOV1 being the most common subtype (74% of gastric varices) 1, 2. However, varices can develop in any gastric location when portal pressure exceeds critical thresholds 3.
Endoscopic Recognition
When evaluating for gastric varices, endoscopists must examine the entire stomach systematically 1:
- Gastric varices may appear as subepithelial masses or large gastric folds 1
- Probing with closed biopsy forceps reveals soft consistency 1
- A blue hue to the lesion suggests variceal nature 1
- Biopsy should be avoided if varices are suspected 1
Important Clinical Caveats
In Fontan-associated liver disease, "downhill varices" can occur in the upper esophagus and stomach due to elevated superior vena cava pressure, representing a different mechanism than typical portal hypertension 1. These can coexist with traditional portal hypertension-derived varices throughout the gastric body 1.
The risk of bleeding varies by location, with fundal varices (GOV2 and IGV1) carrying higher bleeding risk than GOV1 varices along the lesser curvature and body 1, 2.