Involvement of the gastric mucosa is common in children with intrahepatic or extrahepatic causes of portal hypertension.33 Endoscopic findings vary from mild involvement, including a snake-skin mosaic pattern of the mucosa, a fine pink speckling and superficial erythema (scarlatina-type rash), to a severe gastropathy, defined by cherry red spots with a diffuse confluence of reddened areas and a hemorrhagic appearance. These patterns seem to be specific for portal hypertensive gastropathy and have not been found in any of 500 endoscopic examinations performed in children without hepatic disease. The fundus and corpus are usually involved, although antral involvement is occasionally observed. Histologically, portal hypertensive gastropathy is characterized by ectasia of mucosal capillaries and venules and by submucosal venous dilatation, with no acute or chronic inflammation.
Hemodynamic disturbances are thought to be involved in the pathogenesis of portal hypertensive gastropathy, because gastric perfusion alterations parallel the severity of mucosal involvement and previous endoscopic sclerotherapy of esophageal varices both in adults and children may exacerbate mucosal congestion and the severity of gastropathy.34
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