Summary
The present study was intended to assess the incidence and the nature of gastric red spots (GRS) in patients with liver cirrhosis. Endoscopically, GRS was more frequently observed in patients with cirrhosis (n = 146) than those without cirrhosis (n = 103) (43.2% vs. 4.8%; P< 0.001). There was no relationship between the incidence of GRS and the severity of cirrhosis or the size of varices. Portal venous pressure was higher in cirrhotics with GRS (n=21) than those without GRS (n=25) (33.7±6.0 mmHg vs. 28.2±4.8 mmHg; P<0.001). Morphometric analysis using the biopsied specimens was made in 16 cirrhotics with GRS, 12 cirrhotics without GRS, and 15 non-cirrhotics. The capillary bed occupation ratio (vascular area/mucosal area) was higher in cirrhotics with GRS (9.3±4.0%) than those without GRS 84.1 ±1.1%) or the non-cirrhotics (3.4±9.8%) (P< 0.005, P< 0.005), while there was no significant differences in the number of capillaries per unit area. Infiltrating inflammatory cell count was similar among the three groups. Extravascular red blood cell count per unit area was higher in cirrhotics with GRS (29.7±31.4) than those without GRS (5.4±5.1) or non-cirrhotics (5.4±6.3) (P< 0.05, P< 0.01). Furthermore, extravasation of red blood cells through defective portion of the endothelium and interposition of red blood cells in interepithelial spaces were observed electron microscopically in cirrhotics with GRS. These results indicate that (a) the nature of GRS in cirrhotics is preexistential capillary ectasia with intramucosal hemorrhage which is caused by high portal pressure and (b) the GRS in cirrhotics might be a subclinical condition of gastric mucosal hemorrhage.
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References
Merrigan CT, Hollister MR, Gryska, et al: Gastrointestinal bleeding with cirrhosis. N Engl J Med 1960;12:579–585
McCray SR, Martin F, Amir-Ahmadi H, et al: Errouneous diagnosis of hemorrhage from esophageal varices. Digest Dis 1969;14:755–760
Khodadoost J, Glass JBG: Erosive gastritis and acute gastroduodenal ulcerations as source of upper gastrointestinal bleeding in liver cirrhosis. Digestion 1972;7:129–138
Waldram R, Davis M, Nunnerrley H, et al: Emergency endoscopy after gastrointestinal hemorrhage in 50 patients with portal hypertension. Br Med J 1974;12:94–97
Teres J, Bordas JM, Bru C, et al: Upper gastrointestinal bleeding in cirrhosis: Clinical and endoscopic correlation. Gut 1976; 17:37–40
Franco D, Deporte A, Durandy Y, et al: Upper gastrointestinal hemorrhage in cirrhosis. Lancet 1977;l:218–220
Labrec D, Fleury DP, Rueff B: Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 1980;79:1139–1144 692
Sarfeh JI, Tabak C, Eugene J, et al: Clinical significance of erosive gastritis in patients with alcoholic liver disease and upper gastrointestinal hemorrhage. Ann Surg 1981;194:149–151
Iwao T, Toyonaga A, Tanaka J, et al: Endoscopic and clinical study on hemorrhagic gastritis in patients with liver cirrhosis. Digest Endoscopy 1990;2:28–39 (in press)
Kamata T, Kobayashi K, Hatakeyama M: The source of gastrointestinal bleeding in autopsied cases with chronic hepatic disease (abstract). Jpn J Gastroenterol 1978;75:323 (in Japanese)
Enquist IF, & Gliedman ML: Sources of upper gastrointestinal bleeding in patients with cirrhosis. Surg Gyne & Obst 1958;106:153–158
McCormack TT, Sims J, Eyre-Brook I, et al: Gastric lesions in portal hypertension: inflammatory or congestive gastropathy? Gut 1985;26:1226–1232
Papazian A, Brallion A, Dupas LJ, et al: Portal hypertensive gastric mucosa: an endoscopie study. Gut 1986;27:1199–1203
Shimotsuura Y, Toyonaga A: Correlative studies on endoscopie findings and hemodynamics of the gastric mucosa in patients with cirrhosis (abstract). Gastroent Endoscopy 1986:28:1134–1135
Adachi H: The study of gastric mucosal changes and it’s mechanism in patients with liver cirrhosis (abstract). Gastroent Endoscopy 1987:29:455–471
Pugh HN, Murray-Lyon MI, Dawson LJ, et al: Transection of oesophagus for bleeding oesophageal varices. Br J Surg 1973;60: 646–649
Japanese Research Society for Portal Hypertension: The general rules for recording endoscopie findings on esophageal varices. Jap J Surg 1980;10:84–87
Okuda K, Suzuki K, Musha H, et al: Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. A preliminary report. Gastroenterology 1977;73:279–284
Rector WG, Reynolds TB: Risk factors for hemorrhage from esophageal varices and acute gastric ersions. Clinics in Gastroenterology 1985:14:139–153
Sarfeh JI, Tarnawski A, Malki A, et al: Portal hypertension and gastric mucosal injury in rats. Gastroenterology 1983;84:987–993
Lebrec D, Poynard T, Hillon P, et al: Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study. N EngI J Med 1981:305:1371–1374
Lebrec D, Poynard T, Bercoff E, et al: A randomized controlled study of recurrent gastrointestinal bleeding in patients with cirrhosis: final report. Hepatology 1984;4:355–358
Quintero E, Pique MJ, Bombi AJ, et al: Gastric mucosal vascular ectasias causing bleeding in cirrhosis. Gastroenterology 1987:93:1054–1061
Hashizume M, Tanaka K, Inokuchi K: Morphology of gastric microcirculation in cirrhosis. Hepatology 1983:3:1008–1012
Manabe T, Suzuki T, Honjo I: Changes of gastric blood flow in experimentally induced cirrhosis of the liver. Surg Gyne & Obst 1978:17:753–757
Hidaka R: The gastric mucosal blood flow in patient with liver cirrhosis: Special reference to the endoscopie injection sclero therapy and gastric mucosal lesions (abstract). Gastroent Endoscopy 1985:27:1739
Fukuda M, Kawano S, Sato N, et al: Gastric mucosal hemodynamics and oxygen sufficiency in patients with liver cirrhosis assesses by reflectance spectrophotometry (abstract). Jpn J Gastroenterol 1986:83:32 (in Japanese)
Scobie BA, Sumemerskill WHJ: Reduced gastric acid output in cirrhosis: Wuantitation and relationships. Gut 1954;5:422–428
Schmidt HA, Martini GA: Gastric secretion in chronic liver disease. German Medical Monthly 1969:14:246–254
Lam KS: Hypergastrinemia in cirrhosis of liver. Gut 1976;17: 700–708
Sarfeh IJ, Tarnawski A: Functional, histologic and ultrastructural characteristics of the portal hypertensive gastric mucosa. J Gastroenterol Hepatol 1984:4(Suppl l):1–7
Kato K: Endoscopie and histological study of gastric mucosa in liver cirrhosis: With special reference to cases treated with endoscopie injection sclerotherapy for esophageal varices (abstract). Gastroent Endoscopy 1987;29:2166–2176
Fawcett WD: A textbook of histology. Blood and lymphovascular system. 11th Ed, Saundcrs WB company, Philadelphia. 1986:381–391
Tanawski A, Sarfeh IJ, Stachura J, et al: Portal hypertensive gastropathy or vasculopathy? Gastroenterology 1987;92:1786
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Iwao, T., Toyonaga, A. & Tanikawa, K. Gastric red spots in patients with cirrhosis: Subclinical condition of gastric mucosal hemorrhage?. Gastroenterol Jpn 25, 685–692 (1990). https://doi.org/10.1007/BF02779181
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DOI: https://doi.org/10.1007/BF02779181