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07.01.2020 | original article | Ausgabe 1-2/2020 Open Access

Wiener klinische Wochenschrift 1-2/2020

Portal hypertensive gastropathy is associated with iron deficiency anemia

Wiener klinische Wochenschrift > Ausgabe 1-2/2020
MD Benedikt Simbrunner, MD Andrea Beer, MD Katharina Wöran, Fabian Schmitz, MD Christian Primas, MD Marlene Wewalka, MD Matthias Pinter, MD Werner Dolak, MD Bernhard Scheiner, MD Andreas Puespoek, MD Michael Trauner, MD Georg Oberhuber, MD PhD Mattias Mandorfer, MD Thomas Reiberger
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00508-019-01593-w) contains supplementary material, which is available to authorized users.

Author contributions

Study design BS, FS, AP, TR, extraction of data BS, FS, AP, TR, endoscopic work-up CP, MW, MP, WD, AP, MM, TR, statistical analysis BS, FS, MM, TR, critical revision for important intellectual content all authors and drafting of the manuscript BS, TR.

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Background and aims

Portal hypertensive gastropathy (PHG) is common in patients with cirrhosis and may cause bleeding. This study systematically explored the independent impact of patient characteristics, portal hypertension and hepatic dysfunction on PHG severity and associated anemia.


Patients with cirrhosis undergoing endoscopy were included in this retrospective analysis and PHG was endoscopically graded as absent, mild or severe. Clinical and laboratory parameters and hepatic venous pressure gradient (HVPG) were assessed with respect to an association with severity of PHG.


A total of 110 patients (mean age: 57 years, 69% male) with mostly alcoholic liver disease (49%) or viral hepatitis (30%) were included: 15 (13.6%) patients had no PHG, 59 (53.6%) had mild PHG, and 36 (32.7%) had severe PHG. Severe PHG was significantly associated with male sex (83.3% vs. 62.2% in no or mild PHG; p = 0.024) and higher Child-Turcotte-Pugh (CTP) stage (CTP-C: 38.9% vs. 27.0% in no or mild PHG; p = 0.030), while MELD was similar (p = 0.253). Patients with severe PHG had significantly lower hemoglobin values (11.2 ± 0.4 g/dL vs. 12.4 ± 0.2 g/dL; p = 0.008) and a higher prevalence of iron-deficiency anemia (IDA: 48.5% vs. 26.9%; p = 0.032). Interestingly, HVPG was not significantly higher in severe PHG (median 20 mm Hg) vs. mild PHG (19 mm Hg) and no PHG (18 mm Hg; p = 0.252). On multivariate analysis, CTP score (odds ratio, OR: 1.25, 95% confidence interval, CI 1.02–1.53; p = 0.033) was independently associated with severe PHG, while only a trend towards an independent association with IDA was observed (OR: 2.28, 95% CI 0.91–5.72; p = 0.078).


The CTP score but not HVPG or MELD were risk factors for severe PHG. Importantly, anemia and especially IDA are significantly more common in patients with severe PHG.

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