Treatment of Portal Hypertensive Gastropathy with Chronic Haemorrhage in Liver Cirrhosis

Clinical Scenario

This protocol addresses liver cirrhosis complicated by portal hypertensive gastropathy (PHG) — a condition in which elevated portal venous pressure produces mucosal changes in the stomach that result in chronic gastrointestinal haemorrhage.

Persistent blood loss from PHG leads to chronic iron deficiency anaemia, requiring a management strategy that accounts for both the haemorrhagic source and its haematological consequences.

Treatment Approach

The structured protocol for this scenario includes an interventional procedure targeting portal pressure reduction as a key component of management.

The complete regimen — including the specific intervention, clinical criteria, and full sequencing — is available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2018.03.024

NSBB and iron supplementation and/or blood transfusion, when indicated, are recommended as first-line therapy for chronic haemorrhage from PHG is an (I;1).

In patients with transfusion-dependent PHG in whom NSBBs fail or are not tolerated, covered TIPS placement may be used provided the patient has no contraindication for TIPS (II-3;2).

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