Portal Hypertensive Gastropathy: Clinical and Morphological Study of Gastric Mucosal Vascular Bed

Portal hypertensive gastropathy remains an underinvestigated complication of portal hypertension, notwithstanding its frequent occurrence. The morphological features of the gastric mucosal vascular bed and the influence of various clinical factors on the progression of portal hypertensive gastropathy are currently inadequately characterized.

The aim of the study was was to examine the effect of clinical factors on the volumetric density of the vascular bed of the gastric mucosa during the development of portal hypertensive gastropathy.

Material and methods. The study materials comprised gastric mucosal specimens obtained from patients diagnosed with liver cirrhosis at N.I. Pirogov Samara City Clinical Hospital No. 1 between July 2022 and May 2024, including both autopsy (n=43) and biopsy specimens (n=27). Macroscopic evaluation of the gastric mucosa was conducted using data from endoscopic examination and macroscopic description of the gastric wall obtained at autopsy. Histological examination was performed in accordance with standard procedures. Morphometric analysis was carried out by means of gastric mucosal microphotography and manual tracing of vessel lumens, followed by calculation of their count and ross-sectional area. Statistical analysis of the data was performed using nonparametric statistical techniques.

Results. Portal hypertensive gastropathy is characterized by a significant increase in the cross-sectional area of vessels in the antral region and in the vessel count in the gastric body. These indices should be considered the principal morphological alterations of the gastric mucosal vascular bed in portal hypertensive gastropathy.

Conclusion. The indicators identified during the study demonstrate correlation with the severity of liver cirrhosis as assessed by the Child–Pugh score and with macroscopic evaluation based on the Baveno II criteria. Patients presenting with esophageal varices exhibit more pronounced gastric mucosal alterations compared to those without varices. Sex- and age-related factors, as well as viral hepatitis status, do not significantly influence gastric mucosal changes in portal hypertensive gastropathy.

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