Portal hypertensive gastropathy
From Ask Dr Wiki
| Portal hypertensive gastropathy Classification & external resources | ||
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| Image of portal hypertensive gastropathy seen on endoscopy of the stomach. The normally smooth mucosa of the stomach has developed a mosaic like appearance, that resembles snake-skin.}} | ||
| ICD-10 | }} | |
| ICD-9 | 537.89}} | |
| ICD-O: | }} | |
| OMIM | [13] }} | |
| DiseasesDB | [14] }} | |
| MedlinePlus | [15] }} | |
| eMedicine | search | topic list | / }} }} | |
| MeSH | [16] }} | |
| MeSH | {{{MeshNumber}}}}} | |
Portal hypertensive gastropathy refers to changes in the mucosa of the stomach in patients with portal hypertension; by far the most common cause of this is cirrhosis of the liver. These changes in the mucosa include friability (or fragility) of the mucosa and the presence of ectatic (or unusual) blood vessels at the surface. Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopy evaluation of the stomach, this condition shows a characteristic mosaic or "snake-skin" appearance to the mucosa of the stomach.
Contents |
Pathogenesis
Several studies have found that patients with portal hypertension develop increased blood flow to the stomach.[1] The physiological findings that correlate with worsening portal hypertensive gastropathy include an increased portal venous pressure gradient and decreased hepatic blood flow.[2] Biopsies of the stomach in patients with portal hypertensive gastropathy show ectatic (or dilated) blood vessels, evidence of bleeding by means of red blood cells in the lamina propria, and edema in the stomach wall.[3]
Clinical findings
Most patients with portal hypertensive gastropathy have either a stable or improving course in the appearance of the gastropathy on endoscopy. However, according to retrospective data, roughly one in seven patients with portal hypertensive gastropathy will develop bleeding (either acute or chronic) attributable to the gastropathy.[4] Patients with chronic bleeding will usually come to the attention of the medical system because of anemia.
The diagnosis of portal hypertensive gastropathy is usually made on endoscopy. The usual appearance of portal hypertensive gastropathy on endoscopy is a mosaic-like or reticular pattern in the mucosa. Red spots may or may not be present. The pattern is usually seen throughout the stomach.[3] A similar pattern can be seen with a related condition called gastric antral vascular ectasia (GAVE), or watermelon stomach. However, in GAVE, the ectatic blood vessels are more commonly found in the antrum or lower part of the stomach.[3]
Treatment
Image:Gave.png
Argon plasma coagulation, seen here to treat gastric antral vascular ectasia, has also been used to treat bleeding from portal hypertensive gastropathy
Medications
Several treatment options have been developed for portal hypertensive gastropathy. The first is the use of beta-blockers, which reduce portal pressures. Non-selective beta blockers (such as propranolol and nadolol have been used to decrease the pressure of the portal vein in patients with esophageal varices, and have been shown to regress portal hypertensive gastropathy that has been worsened by medical treatment of varices.[5] Propranolol has also been evaluated in patients with chronic cirrhosis and portal hypertensive gastropathy [6] Other medications that primarily treat bleeding, including anti-fibrinolytic medications such as tranexamic acid have also been used in case reports of patients with portal hypertensive gastropathy.[7] These medications work by stabilizing deposits of fibrin at sites that ordinarily would bleed.
Finally, octreotide, an analogue of somatostatin that leads to vasoconstriction of the portal circulation, can be used for active bleeding due to portal hypertensive gastropathy.[8] Sucralfate, a coating medication has also been used, but evidence is from animal models.[9]
Procedural
Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse.[10][8]
Transcutaneous intrahepatic portosystemic shunt procedures, or TIPS involve decompressing the portal vein by shunting a portal venule to a lower pressure systemic venule, under guidance with fluoroscopy. Since it treats the root cause of portal hypertension gastropathy, it has been putatively used for the condition. The literature reports suggest both regression of portal hypertensive gastropathy on endoscopic images and improvement in bleeding after TIPS.[11]
Finally, cryotherapy involves the use of pressurized carbon dioxide administered through the endoscope to freeze and destroy tissue in a focal area. It is being studied for the treatment of portal hypertensive gastropathy.[12]
Similar conditions
Congestion of the mucosa in other parts of the gastrointestinal tract can also be seen in portal hypertension. When the condition involves the colon, it is termed portal hypertensive colopathy.[13]
References
- ↑ {{#if:Iwao T, Toyonaga A, Sumino M, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Iwao T, Toyonaga A, Sumino M, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Iwao T, Toyonaga A, Sumino M, et al }} }} }}{{#if:Iwao T, Toyonaga A, Sumino M, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1992 |{{#if: | ({{{month}}} 1992) | (1992) }} }} }}{{#if:Iwao T, Toyonaga A, Sumino M, et al | . }}{{#if:Iwao T, Toyonaga A, Sumino M, et al1992 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Portal hypertensive gastropathy in patients with cirrhosis] |Portal hypertensive gastropathy in patients with cirrhosis }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastroenterology |. Gastroenterology }}{{#if:102 | 102 }}{{#if:6 | (6) }}{{#if:2060-5 |: 2060-5 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[1] }}{{#if: |. ISSN {{{issn}}} }}{{#if:1587424 |. PMID 1587424 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS }} }} }}{{#if:Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1998 |{{#if: | ({{{month}}} 1998) | (1998) }} }} }}{{#if:Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS | . }}{{#if:Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS1998 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Gastric mucosal blood flow and hepatic perfusion index in patients with portal hypertensive gastropathy] |Gastric mucosal blood flow and hepatic perfusion index in patients with portal hypertensive gastropathy }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:J. Gastroenterol. Hepatol. |. J. Gastroenterol. Hepatol. }}{{#if:13 | 13 }}{{#if:9 | (9) }}{{#if:921-6 |: 921-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[2] }}{{#if: |. ISSN {{{issn}}} }}{{#if:9794191 |. PMID 9794191 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ 3.0 3.1 3.2 {{#if:Thuluvath PJ, Yoo HY |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Thuluvath PJ, Yoo HY }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Thuluvath PJ, Yoo HY }} }} }}{{#if:Thuluvath PJ, Yoo HY |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2002 |{{#if: | ({{{month}}} 2002) | (2002) }} }} }}{{#if:Thuluvath PJ, Yoo HY | . }}{{#if:Thuluvath PJ, Yoo HY2002 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Portal Hypertensive gastropathy] |Portal Hypertensive gastropathy }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Am. J. Gastroenterol. |. Am. J. Gastroenterol. }}{{#if:97 | 97 }}{{#if:12 | (12) }}{{#if:2973-8 |: 2973-8 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[3] }}{{#if: |. ISSN {{{issn}}} }}{{#if:12492178 |. PMID 12492178 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Primignani M, Carpinelli L, Preatoni P, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Primignani M, Carpinelli L, Preatoni P, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Primignani M, Carpinelli L, Preatoni P, et al }} }} }}{{#if:Primignani M, Carpinelli L, Preatoni P, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2000 |{{#if: | ({{{month}}} 2000) | (2000) }} }} }}{{#if:Primignani M, Carpinelli L, Preatoni P, et al | . }}{{#if:Primignani M, Carpinelli L, Preatoni P, et al2000 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC)] |Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC) }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastroenterology |. Gastroenterology }}{{#if:119 | 119 }}{{#if:1 | (1) }}{{#if:181-7 |: 181-7 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[4] }}{{#if: |. ISSN {{{issn}}} }}{{#if:10889167 |. PMID 10889167 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Lo GH, Lai KH, Cheng JS, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lo GH, Lai KH, Cheng JS, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lo GH, Lai KH, Cheng JS, et al }} }} }}{{#if:Lo GH, Lai KH, Cheng JS, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2001 |{{#if: | ({{{month}}} 2001) | (2001) }} }} }}{{#if:Lo GH, Lai KH, Cheng JS, et al | . }}{{#if:Lo GH, Lai KH, Cheng JS, et al2001 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial] |The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:53 | 53 }}{{#if:6 | (6) }}{{#if:579-84 |: 579-84 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[5] }}{{#if: |. ISSN {{{issn}}} }}{{#if:11323582 |. PMID 11323582 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Pérez-Ayuso RM, Piqué JM, Bosch J, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Pérez-Ayuso RM, Piqué JM, Bosch J, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Pérez-Ayuso RM, Piqué JM, Bosch J, et al }} }} }}{{#if:Pérez-Ayuso RM, Piqué JM, Bosch J, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1991 |{{#if: | ({{{month}}} 1991) | (1991) }} }} }}{{#if:Pérez-Ayuso RM, Piqué JM, Bosch J, et al | . }}{{#if:Pérez-Ayuso RM, Piqué JM, Bosch J, et al1991 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis] |Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Lancet |. Lancet }}{{#if:337 | 337 }}{{#if:8755 | (8755) }}{{#if:1431-4 |: 1431-4 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[6] }}{{#if: |. ISSN {{{issn}}} }}{{#if:1675316 |. PMID 1675316 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:McCormick PA, Ooi H, Crosbie O |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |McCormick PA, Ooi H, Crosbie O }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |McCormick PA, Ooi H, Crosbie O }} }} }}{{#if:McCormick PA, Ooi H, Crosbie O |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1998 |{{#if: | ({{{month}}} 1998) | (1998) }} }} }}{{#if:McCormick PA, Ooi H, Crosbie O | . }}{{#if:McCormick PA, Ooi H, Crosbie O1998 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis] |Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gut |. Gut }}{{#if:42 | 42 }}{{#if:5 | (5) }}{{#if:750-2 |: 750-2 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[7] }}{{#if: |. ISSN {{{issn}}} }}{{#if:9659175 |. PMID 9659175 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ 8.0 8.1 {{#if:Garcia N, Sanyal AJ |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Garcia N, Sanyal AJ }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Garcia N, Sanyal AJ }} }} }}{{#if:Garcia N, Sanyal AJ |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2001 |{{#if: | ({{{month}}} 2001) | (2001) }} }} }}{{#if:Garcia N, Sanyal AJ | . }}{{#if:Garcia N, Sanyal AJ2001 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia] |Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if: |. ' }}{{#if:4 | 4 }}{{#if:2 | (2) }}{{#if:163-171 |: 163-171 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[8] }}{{#if: |. ISSN {{{issn}}} }}{{#if:11469974 |. PMID 11469974 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P }} }} }}{{#if:Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1987 |{{#if: | ({{{month}}} 1987) | (1987) }} }} }}{{#if:Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P | . }}{{#if:Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P1987 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats] |Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:J. Hepatol. |. J. Hepatol. }}{{#if:5 | 5 }}{{#if:2 | (2) }}{{#if:162-6 |: 162-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[9] }}{{#if: |. ISSN {{{issn}}} }}{{#if:3693860 |. PMID 3693860 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Sato T, Yamazaki K, Toyota J, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sato T, Yamazaki K, Toyota J, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sato T, Yamazaki K, Toyota J, et al }} }} }}{{#if:Sato T, Yamazaki K, Toyota J, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2005 |{{#if: | ({{{month}}} 2005) | (2005) }} }} }}{{#if:Sato T, Yamazaki K, Toyota J, et al | . }}{{#if:Sato T, Yamazaki K, Toyota J, et al2005 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Efficacy of argon plasma coagulation for gastric antral vascular ectasia associated with chronic liver disease] |Efficacy of argon plasma coagulation for gastric antral vascular ectasia associated with chronic liver disease }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Hepatol. Res. |. Hepatol. Res. }}{{#if:32 | 32 }}{{#if:2 | (2) }}{{#if:121-6 |: 121-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1016/j.hepres.2005.04.004 |. doi:10.1016/j.hepres.2005.04.004 }}{{#if: |. ISSN {{{issn}}} }}{{#if:15967712 |. PMID 15967712 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Urata J, Yamashita Y, Tsuchigame T, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Urata J, Yamashita Y, Tsuchigame T, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Urata J, Yamashita Y, Tsuchigame T, et al }} }} }}{{#if:Urata J, Yamashita Y, Tsuchigame T, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1998 |{{#if: | ({{{month}}} 1998) | (1998) }} }} }}{{#if:Urata J, Yamashita Y, Tsuchigame T, et al | . }}{{#if:Urata J, Yamashita Y, Tsuchigame T, et al1998 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy] |The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:J. Gastroenterol. Hepatol. |. J. Gastroenterol. Hepatol. }}{{#if:13 | 13 }}{{#if:10 | (10) }}{{#if:1061-7 |: 1061-7 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[10] }}{{#if: |. ISSN {{{issn}}} }}{{#if:9835325 |. PMID 9835325 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Clarke JO, Thuluvath PJ |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Clarke JO, Thuluvath PJ }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Clarke JO, Thuluvath PJ }} }} }}{{#if:Clarke JO, Thuluvath PJ |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Clarke JO, Thuluvath PJ | . }}{{#if:Clarke JO, Thuluvath PJ2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic frontiers in the field of hepatology] |Endoscopic frontiers in the field of hepatology }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Minerva gastroenterologica e dietologica |. Minerva gastroenterologica e dietologica }}{{#if:53 | 53 }}{{#if:1 | (1) }}{{#if:101-9 |: 101-9 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[11] }}{{#if: |. ISSN {{{issn}}} }}{{#if:17415347 |. PMID 17415347 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
- ↑ {{#if:Bini EJ, Lascarides CE, Micale PL, Weinshel EH |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Bini EJ, Lascarides CE, Micale PL, Weinshel EH }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Bini EJ, Lascarides CE, Micale PL, Weinshel EH }} }} }}{{#if:Bini EJ, Lascarides CE, Micale PL, Weinshel EH |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2000 |{{#if: | ({{{month}}} 2000) | (2000) }} }} }}{{#if:Bini EJ, Lascarides CE, Micale PL, Weinshel EH | . }}{{#if:Bini EJ, Lascarides CE, Micale PL, Weinshel EH2000 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study] |Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:52 | 52 }}{{#if:4 | (4) }}{{#if:511-6 |: 511-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[12] }}{{#if: |. ISSN {{{issn}}} }}{{#if:11023569 |. PMID 11023569 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
