Publication

Abstract : Background: Portal Hypertensive Gastropathy (PHG) is an important source of gastrointestinal bleeding in patients with portal hypertension. Aim: To assess the progression to severe portal hypertensive gastropathy (PHG) in patients with cirrhosis who were treated with maximum tolerated dose of propranalol, after variceal eradication to grade II or below. Methods: Cirrhotic patients (child A and B) presenting with upper gastrointestinal bleeding with endoscopic findings of mild or no PHG were followed up over 6 months after variceal eradication to assess the progression to severe PHG. Included patients were randomized to either maximum tolerated doses of propranolol (group A) or to no treatment (group B). Primary end points of the study were the development of gastrointestinal bleed, evidence of hepatic decompensation and death. Progression to severe PHG was compared between the two groups. Results: Fifty six patients (49 males) were enrolled (group A = 28, group B = 28). Eight patients were excluded from final analysis (GI bleed=5, encephalopathy=2, HCC=1 including 4 deaths). Three patients were lost to follow up, and 1 developed intolerance to propranalol. Mean dose of propranalol used was 60 mg per day. Progression to severe PHG in the fundus over 6 months was 23.8% in group A versus 15.8 % in group B (P = 0.52). Severe PHG was noted in body in 14.3% in group A versus 21.1% in group B (P = 0.57). Approximate 24 % in group A had progression to severe PHG compared with 15.8 % in group B (P = 0.52). There was no statistically significant difference in the progression of PHG between the two groups (P = 0.43). Conclusion: In this short term study propranalol was found not to prevent the progression to severe portal hypertensive gastropathy in cirrhotic patients who had undergone endotherapy for esophageal varices.