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Surgical Pathology Criteria

Portal Hypertensive Gastropathy


  • Gastric vascular changes associated with portal hypertension

Diagnostic Criteria

  • Dilated, tortuous vessels in submucosa of gastric body
    • May not be visible on shallow biopsy specimens
    • Mucosal vascular distension
    • Nearly always associated with portal hypertension due to cirrhosis
  • Endoscopic appearance
    • Cherry red spots
      • May resemble scarlatina rash
    • White reticular pattern
      • May resemble snakeskin
    • Mosaic appearance in proximal stomach
  • Responds to lowering of portal pressure

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates : 9/9/09, 4/16/10

Differential Diagnosis

Portal Hypertensive Gastropathy Gastric Antral Vascular Ectasia
Involves fundus and corpus Involves antrum
Endoscopic diffuse changes Endoscopic longitudinal stripes
Secondary to cirrhosis May be associated with cirrhosis
No microthrombi Microthrombi characteristic
No fibromuscular change or hyalinization in lamina propria Fibromuscular hyperplasia with hyalinization of lamina propria

Classification / Lists

Gastritis / Gastropathy


  • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
  • Vesoulis Z, Naik N, Maseelall P. Histopathologic changes are not specific for diagnosis of gastric antral vascular ectasia (GAVE) syndrome: a review of the pathogenesis and a comparative image analysis morphometric study of GAVE syndrome and gastric hyperplastic polyps. Am J Clin Pathol. 1998 May;109(5):558-64.
  • Gretz JE, Achem SR. The watermelon stomach: clinical presentation, diagnosis, and treatment. Am J Gastroenterol. 1998 Jun;93(6):890-5.
  • Srivastava A, Lauwers GY. Pathology of non-infective gastritis.Histopathology. 2007 Jan;50(1):15-29.
  • Westerhoff M, Tretiakova M, Hovan L, Miller J, Noffsinger A, Hart J. CD61, CD31, and CD34 improve diagnostic accuracy in gastric antral vascular ectasia and portal hypertensive gastropathy: An immunohistochemical and digital morphometric study. Am J Surg Pathol. 2010 Apr;34(4):494-501.
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