Portal Hypertensive Gastropathy Location
Portal hypertensive gastropathy (PHG) primarily affects the fundus and body of the stomach, not the antrum. 1
Anatomic Distribution
The characteristic mucosal changes of PHG occur in the proximal stomach (fundus and body), which distinguishes it from gastric antral vascular ectasia (GAVE). 1, 2
- The Korean Association for the Study of the Liver (KASL) guidelines explicitly state that PHG "causes gastric mucosal changes in the stomach and body" 1
- The endoscopic mosaic or "snake-skin" pattern has a proximal distribution in the fundus and body 2
- This proximal location is a key diagnostic feature that helps differentiate PHG from other gastric vascular lesions 2, 3
Critical Distinction: PHG vs GAVE
Understanding the anatomic difference between PHG and GAVE is essential because they require completely different treatments: 1, 4
Portal Hypertensive Gastropathy (PHG):
- Location: Fundus and body (proximal stomach) 1, 2
- Appearance: Mosaic or "snake-skin" pattern with or without red spots 1, 2, 5
- Treatment: Non-selective beta-blockers are first-line therapy 1, 2
Gastric Antral Vascular Ectasia (GAVE):
- Location: Gastric antrum (distal stomach) 1, 4, 2
- Appearance: Red spots in linear distribution ("watermelon stomach") without mosaic pattern 2, 3
- Treatment: Argon plasma coagulation; beta-blockers are NOT effective 2
Clinical Pitfall
The most important clinical pitfall is confusing PHG with GAVE, as approximately 30% of GAVE patients also have portal hypertension, which can lead to diagnostic confusion. 1, 4 However, the anatomic location (proximal vs. distal stomach) and endoscopic appearance are the key distinguishing features that guide appropriate treatment selection 2, 3