Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome

PHG commonly occurs in the setting of cirrhosis and portal hypertension but can also complicate portal hypertension in the non-cirrhotic patient. Generally the incidence of PHG increases with increasing severity of liver disease and has been found to be associated with the presence of both oesophageal and gastric varices. Furthermore, the presence of PHG in the setting of oesophageal varices has been found to be a strong predictor of future oesophageal variceal bleeding. The exact aetiology of PHG is presently unclear but obliteration of oesophageal varices may increase its incidence. Therapy of PHG is directed at lowering portal pressure via β blockers or shunt procedures. GAVE syndrome typically occurs in non-cirrhotic patients and is managed with endoscopic coagulation or surgery. When GAVE syndrome complicates cirrhosis, it is essential to differentiate it from PHG because therapies directed at reducing portal pressures are not effective treatment for GAVE syndrome.