Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis

Background/Aims : Whereas severe portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) have been separately defined in patients with cirrhosis, there is much confusion in the literature because they are both characterized by red spots at endoscopy. This prospective study compared clinical, biochemical, and pathological features of these syndromes. Methods : Three groups of patients with cirrhosis and either GAVE (n = 14), severe portal hypertensive gastropathy (n = 14), or no gastric features at endoscopy (controls; n = 10) were included. Results : No difference was found between patients with gastropathy and controls. Patients with GAVE presented with the following significant differences compared with other patients: a higher Child-Pugh score, a lower blood level of hemoglobin and gastrin, and a higher intestinal blood loss. At pathological examination, these patients more frequently had vascular ectasia ( P = 0.04), spindle cell proliferation ( P < 0.01), fibrohyalinosis ( P = 0.004), and Gilliam's score of ≥2 ( P < 0.05); thrombi were encountered only in patients with GAVE ( P = 0.006). Using discriminant analysis, spindle cell proliferation and fibrohyalinosis were the only significant variables yielding a diagnostic accuracy of 85% for GAVE and gastropathy. Conclusions : GAVE and severe portal hypertensive gastropathy are two distinct entities.