The significance of portal hypertensive gastropathy in patients with asymptomatic primary biliary cholangitis

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  • Takeshita Eiji
    Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine
  • Yamamoto Yasunori
    Endoscopy center, Ehime University Hospital
  • Yagi Sen
    Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine
  • Hashimoto Yu
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Tange Kazuhiro
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Hanayama Masakazu
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Tanaka Takaaki
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Tokumoto Yoshio
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Hirooka Masashi
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Abe Masanori
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Ikeda Yoshio
    Endoscopy center, Ehime University Hospital
  • Hiasa Yoichi
    Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine

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Other Title
  • 原発性胆汁性胆管炎における門脈圧亢進症性胃症合併の意義
  • ゲンパツセイ タンジュウセイタンカンエン ニ オケル モンミャクアツ コウシンショウセイ イショウ ガッペイ ノ イギ

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<p>Esophagogastric varices is one of the most important clinical symptoms in patients with primary biliary cholangitis (PBC) in addition to jaundice and skin itching, since the varices are in general intractable, and frequently recur following endoscopic therapies. Thus, careful observation of varices should be done in patients with PBC. On the other hand, portal hypertensive gastropathy (PHG) may develop in patients manifesting portal hypertension, and these gastrointestinal disorders are seen even in patients with asymptomatic PBC (a-PBC). The significance of PHG, however, is not clarified in patients with a-PBC, and endoscopic examinations were done serially in patients with PBC. A total of 112 patients with a-PBC were enrolled. Among them, PHG was found in 21 patients (21.9%) at baseline, and developed in 6 patients (5.4%) following the enrollment. When clinical features were compared between 27 patients with PHG and the remaining 85 patients, the cumulative survival rates did not differ between both groups, while the periods until diagnosis as having symptomatic PBC were shorter in the former patients than in the latter patients, and a percentage of patients in whom esophagogastric varices developed during the observation periods were higher in the former patients than in the latter patients (74% vs 40%). Moreover, a multivariate analysis revealed that PHG was a significant factor responsible for progression to symptomatic PBC in patients with a-PBC. These results suggest that the frequency of patients with a-PBC who will be diagnosed as having portal hypertension-type symptomatic PBC in the future is higher in those with PHG than in those without PHG, and careful observations for portal hypertension-related events as well as jaundice and skin itching are require for such patients.</p>

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