Correlation between portal hypertensive gastropathy with etiology of decompensated chronic liver disease

Introduction: Portal hypertensive gastropathy (PHG) is a common complication of chronic liver disease and portal hypertension (PHTN). Many studies showed PHTN related hemodynamic changes play major role in development of PHG (1), due to contrary studies portal hypertension cannot be the sole factor[2,3]. Patho-physiology of PHG not well established till date (4). New hypothesis for PHG development are local and systemic inflammatory factors due to underlying CLD and etiology of CLD play the major role(59,10,11).
Aim: To find out prevalence of PHG across the common etiologies of DCLD and correlation between PHG and etiology of DCLD.
Methods: We conducted prospective cross-sectional analytic study. The study protocol was approved by the ethical review board. We included a total of 400 DCLD (CTP class B/C) patients with established etiology and also cryptogenic who underwent endoscopy in medical gastroenterology department from June 2016 to december 2018. Informed consent was taken from all patients. Among 400 patients of DCLD 130 alcoholic liver disease, 70 HBV, 60 HCV, 80 cryptogenic, 40 NAFLD, 10 wilson's, 6 autoimmune and 4 secondary biliary cirrhosis related patients were present. PHG was diagnosed according to NIEC classification by EGD(12). Prevalence of PHG in each group of patient calculated in percentage. Association between etiology of DCLD and PHG was assessed by logistic regression analysis. OR (odds ratio) with 95% CI calculated. Considered significant association when p value <0.05
Results: PHG were present in 76.9%(100/130), 64%(45/70), 70%(42/60), 32.5% (26/80), 70%(28/40), 40%(4/10), 66.6%(4/6) and 25%(1/4) of Ethanol, HBV, HCV, cryptogenic, NAFLD, Wilson's, autoimmune hepatitis, and secondary biliary cirrhosis related DCLD patients respectively. Logistic regression analysis shows ethanol, HBV, HCV, Autoimmune etiology of DCLD significantly associated with PHG.
Conclusion: PHG is one of the most common complications of DCLD with PHN but factors implicating in pathogenesis are inconclusive. Our study showed etiologies of DCLD like ethanol, HBV, HCV and autoimmune hepatitis having higher prevalence and significant association with PHG.