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Portal Gastropathy and Duodenopathy in Children With Extrahepatic and Intrahepatic Portal Hypertension: Endoscopic Diagnosis and Histologic Scoring

Aydoğan, Ayşen*; Güllüoğlu, Mine; Önder, Semen Yeşil; Gökçe, Selim*; Çeltik, Coşkun*; Durmaz, Özlem*

Journal of Pediatric Gastroenterology & Nutrition: May 2011 - Volume 52 - Issue 5 - p 612–616
doi: 10.1097/MPG.0b013e3182125e7c
Original Articles: Hepatology and Nutrition

Objectives: The aim of the study was to determine the frequency of portal gastropathy (PG) and duodenopathy (PD) in children, to document the correlation of various clinical and laboratory parameters associated with portal hypertensive gastroduodenal lesions, to compare the endoscopic portal hypertensive lesions with different histologic findings, and to evaluate the use of a possible histologic scoring system.

Methods: All children undergoing endoscopic investigation for portal hypertension (PH) between January 2006 and November 2007 were analysed retrospectively. Clinical and demographical data and endoscopic and histologic findings were recorded. Histologic findings suggestive of PG and PD (capillary dilation, increased numbers of capillaries, histologic bleeding, and edema) were scored.

Results: Of 51 consecutive children (29 boys, mean age 10.1± 3.6 years [range 2.5–15.8 years]), 28 were cirrhotic. PG was diagnosed in 58.8% endoscopically. Children with cirrhotic PH had the highest rate of PG (64.3%), whereas those with extrahepatic or intrahepatic noncirrhotic PH were alike (50% and 54.5%, respectively). Baveno PG scores were higher in children with cirrhosis with higher Child-Pugh scores. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis. Only 9% had PD on endoscopy. None of the histologic findings correlated with endoscopic diagnosis of PD.

Conclusions: PG and PD are seen in children with extrahepatic and intrahepatic PH at rates similar to those reported in adult studies. Baveno PG scores increased in parallel with Child-Pugh class in children with cirrhosis. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis of PG in this study.

*Departments of Pediatric Gastroentrology, Hepatology, and Nutrition, Turkey

Pathology, Istanbul University Faculty of Medicine, Istanbul, Turkey.

Received 24 November, 2010

Accepted 25 January, 2011

Address correspondence and reprint requests to Özlem Durmaz, MD, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Istanbul University School of Medicine, Istanbul, Turkey (e-mail: odsuoglu@istanbul.edu.tr).

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN