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Portal Hypertensive Gastropathy (PHG) is a condition characterized by mucosal and submucosal vascular changes in the stomach due to portal hypertension, leading to chronic blood loss and anemia, or less commonly, acute upper GI bleeding.

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• It is distinct from gastric varices and GAVE (gastric antral vascular ectasia).

Etiopathogenesis

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Underlying mechanism: Increased portal venous pressure → congestion and dilatation of submucosal capillaries and venules in the stomach.

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Risk factors:

• Cirrhosis (most common cause).
• Non-cirrhotic portal hypertension (e.g., extrahepatic portal vein obstruction, schistosomiasis).
• Severity correlates with degree and duration of portal hypertension, not always with Child-Pugh class.

Clinical Features

• Often asymptomatic, discovered on surveillance endoscopy in cirrhotics.
• Chronic presentation: Iron-deficiency anemia due to occult blood loss.
• Acute presentation (rare): Hematemesis or melena (mild to moderate bleed, rarely massive).

Endoscopic Features (Gold Standard)

• Mosaic / Snake-skin appearance of gastric mucosa (most often in fundus and body).
• Superimposed red spots / cherry-red lesions = severe PHG → risk of bleeding.
• Distribution: Proximal stomach (fundus and body), unlike GAVE (antrum).

Histopathology