What Is Portal Hypertensive Gastropathy?

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Portal hypertensive gastropathy (PHG) refers to changes in the stomach lining caused by elevated blood pressure in the portal vein (the main vein that leads to the liver). This increase in blood pressure in the portal vein is known as portal hypertension. It is commonly caused by cirrhosis (scarring of the liver). PHG can cause changes to the entire gastrointestinal tract and lead to internal bleeding.

This article will discuss the symptoms, causes, and treatment for portal hypertensive gastropathy.

Mild vs. Severe Portal Hypertensive Gastrophy

Verywell / Shideh Ghandeharizadeh

Types of Portal Hypertensive Gastropathy

There are two categories of portal hypertensive gastropathy: mild and severe. This classification is based on the degree of changes to the stomach lining as follows:

  • Mild PHG: In mild PHG, a snakeskin mosaic pattern appears on the lining of the stomach.
  • Severe PHG: In severe PHG, the snakeskin pattern will appear along with other changes to the lining. These changes can consist of flat or bulging red or black-brown spots, an irregular shape of the lining, and oozing. In this stage there may also be bleeding inside the stomach.


Most people with PHG do not have immediate symptoms. However, if PHG worsens, it can lead to later-stage symptoms, including:

  • Bleeding in the stomach
  • Anemia (lack of healthy red blood cells)
  • Poor wound healing
  • Increased susceptibility to side effects from ingested toxins, such as medications, foods, and alcohol

PHG mainly affects the mucosa, or lining, of the stomach. Changes to the mucosa, such as red or black-brown spots or flat or bulging marks, would only be noticeable during an endoscopy, a procedure in which a thin, lighted tube is inserted through the mouth to get a view of the inside of the gastrointestinal tract.


The most common risk factor for developing PHG is portal hypertension, an increase in blood pressure in the main vein leading to the liver.

Portal hypertension is commonly caused by liver disease.

Liver disease can result from excessive alcohol use, hepatitis B or hepatitis C infection, or a severe form of nonalcoholic fatty liver disease (NAFLD), in which excess fat builds up in the liver.

Portal Hypertension Without Liver Disease

In some cases, portal hypertension can occur without liver disease. This is known as non-cirrhotic portal hypertension. Non-cirrhotic portal hypertension can be caused by exposure to medications or toxins, certain diseases that affect the immune system such as Crohn’s disease, chronic infection, a genetic predisposition, and clotting disorders.


To diagnose PHG, your healthcare provider will start by taking a full medical and family history.

If you have any of the underlying causes of PHG, such as liver disease or portal hypertension, your healthcare provider may order an esophagogastroduodenoscopy, a procedure that looks inside the stomach. This is also known as an upper endoscopy.

During the procedure, your healthcare provider, who may be a gastroenterologist (a specialist who diagnoses and treats disorders of the digestive tract), will look for changes to the lining of the stomach. In some cases, they may order a capsule endoscopy, which also looks at the stomach lining.

With either test, if they notice the telltale signs of PHG on the lining of your stomach, such as the snakeskin pattern or bleeding, and you have the other risk factors, you will most likely be diagnosed with PHG.


Treatment for PHG depends on the severity of symptoms and if bleeding is present.

For chronic, long-term bleeding, you may be given iron-replacement medications or a blood transfusion to treat anemia. You may also be prescribed nonselective beta-blockers, such as Inderal (propranolol), to help control the bleeding.

For acute or current bleeding, treatment can include:

  • Intravenous (IV) fluids
  • Blood transfusion
  • Antibiotics
  • Vasoactive drugs that increase or decrease blood pressure and heart rate

To help prevent future bleeding, your healthcare provider may again prescribe nonselective beta-blockers.


While PHG can be treated and managed, it is also important to treat and manage the underlying cause or causes for the best outcome. Liver disease and portal hypertension, the most common causes of PHG, should be treated early to prevent further complications.

It's important to talk to your healthcare provider about your condition and to follow their recommended treatment plan. Left untreated, portal hypertension can lead to other complications and can potentially be fatal.

A Word From Verywell

Having a secondary condition like PHG on top of liver disease can feel overwhelming. Even if you aren’t experiencing symptoms from PHG, you may still have concerns about your future health. This is to be expected with a chronic condition. Regularly speaking with your healthcare provider can help you manage multiple diseases at the same time.

7 Sources
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