Extensive mucosal erythema under gastroscopy

Introduction Gastroscopically, extensive mucosal erythema is a clinical manifestation of portal hypertensive gastropathy. It should be differentiated from various stomach symptoms. In particular, it should be differentiated from gastric mucosal congestion and edema. Gastric mucosal congestion and edema is caused by reflux of bile, pancreatic juice and intestinal alkaline fluid into the stomach.

Cause

Cause: A wide range of mucosal erythema under gastroscope is suffering from portal hypertensive gastropathy.

1. Mucosal circulatory disorder: normal gastric mucosa can concentrate H 1 million times, maintaining a high H concentration gradient between the gastric cavity and the stomach wall. The gastric mucosa relies on abundant blood flow to clear the H into the stomach wall and the portal pressure. Hemodynamic changes after elevation, submucosal vasodilation, arteriovenous traffic, venous and capillary varices, venous congestion, increased submucosal blood flow, and reduced mucosal blood supply cause ischemia and hypoxia.

2. Liver function status: 18.6% of patients with normal or mild liver function developed acute gastric mucosal lesions and hemorrhage, and 55.5% of patients with severe liver dysfunction.

3. Bile reflux: In portal hypertension, gastrointestinal congestion and hypergastrinemia, inhibition of cholecystokinin and secretin regulation of the pyloric sphincter and Oddi sphincter, make it relax, bile and twelve fingers The intestinal contents flow back into the stomach, causing bile reflux gastritis.

4. Endotoxemia: patients with portal hypertension often have endotoxemia, liver function decompensation is more common, such as acute liver failure 66% ~ 100% with endotoxemia; patients with hepatic encephalopathy The rate was about 93%; the incidence of gastrointestinal bleeding was 53.8%.

5. Infection: Hepatitis B virus exists in gastric mucosal epithelial cells, which form an antigen-antibody complex and deposit in microvascular endothelial cells, causing an inflammatory reaction and destroying the gastric mucosal barrier.

6. Stress response: Critically ill patients, including severe liver patients, often develop stress response, resulting in decreased gastrointestinal mucosal blood flow, ischemia and hypoxia and a series of pathophysiological changes.

an examination

Related inspection

Gastroscopy fiber gastroscopy

Diagnosis: mainly relies on gastroscope to make diagnosis. Patients with cirrhotic portal hypertension have extensive mucosal erythema and mosaic signs under gastroscope. Gastric mucosa, especially red spots or multiple red spots and spontaneous bleeding in the bottom of the stomach, can be diagnosed. . Gastroscopic biopsy is small and superficial. In addition to a certain degree of congestion, there are no obvious abnormalities, which does not help the diagnosis of PHG. It is also reported that 50% of endoscopic biopsy specimens have telangiectasia.

Differential diagnosis

It should be differentiated from various stomach symptoms. In particular, it should be differentiated from gastric mucosal congestion and edema. Gastric mucosal congestion and edema is caused by reflux of bile, pancreatic juice and intestinal alkaline fluid into the stomach.

Diagnosis: Mainly relying on gastroscope to make diagnosis. Patients with cirrhotic portal hypertension show extensive mucosal erythema and mosaic sign under gastroscope. Gastric mucosa, especially red spots or multiple red spots and spontaneous bleeding in the bottom of the stomach, can be diagnosed. . Gastroscopic biopsy is small and superficial. In addition to a certain degree of congestion, there are no obvious abnormalities, which does not help the diagnosis of PHG. It is also reported that 50% of endoscopic biopsy specimens have telangiectasia.

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