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__NOTOC__
__NOTOC__
{{Gastrointestinal varices}}
{{Gastrointestinal varices}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{HK}}


==Overview==
==Overview==
Causes of gastointestinal varices include all the causes of increased [[Portal venous system|portal venous pressure]], which may be divided into [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]] causes.


==Causes==
==Causes==
*Gastrointestinal varices (especially esophageal and gastric) are due to increased pressure in the portal venous system
*Gastrointestinal varices (especially esophageal and gastric) are due to increased pressure in the [[portal venous system]]
*The major causes of portal hypertension may be broadly categorized into cirrhotic and non-cirrhotic
*The major causes of [[portal hypertension]] may be broadly categorized into [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]]<ref name="pmid11831999">{{cite journal |vauthors=Li X, Gao W, Chen J, Tang W |title=[Non-cirrhotic portal hypertension associated with autoimmune disease] |language=Chinese |journal=Zhonghua Wai Ke Za Zhi |volume=38 |issue=2 |pages=101–3 |year=2000 |pmid=11831999 |doi= |url=}}</ref><ref name="pmid3276575">{{cite journal |vauthors=Kono K, Ohnishi K, Omata M, Saito M, Nakayama T, Hatano H, Nakajima Y, Sugita S, Okuda K |title=Experimental portal fibrosis produced by intraportal injection of killed nonpathogenic Escherichia coli in rabbits |journal=Gastroenterology |volume=94 |issue=3 |pages=787–96 |year=1988 |pmid=3276575 |doi= |url=}}</ref><ref name="pmid17558079">{{cite journal |vauthors=Kumar S, Joshi R, Jain AP |title=Portal hypertension associated with sickle cell disease |journal=Indian J Gastroenterol |volume=26 |issue=2 |pages=94 |year=2007 |pmid=17558079 |doi= |url=}}</ref><ref name="pmid18685811">{{cite journal |vauthors=Bayan K, Tüzün Y, Yilmaz S, Canoruc N, Dursun M |title=Analysis of inherited thrombophilic mutations and natural anticoagulant deficiency in patients with idiopathic portal hypertension |journal=J. Thromb. Thrombolysis |volume=28 |issue=1 |pages=57–62 |year=2009 |pmid=18685811 |doi=10.1007/s11239-008-0244-8 |url=}}</ref><ref name="pmid15832360">{{cite journal |vauthors=Girard M, Amiel J, Fabre M, Pariente D, Lyonnet S, Jacquemin E |title=Adams-Oliver syndrome and hepatoportal sclerosis: occasional association or common mechanism? |journal=Am. J. Med. Genet. A |volume=135 |issue=2 |pages=186–9 |year=2005 |pmid=15832360 |doi=10.1002/ajmg.a.30724 |url=}}</ref><ref name="pmid18389904">{{cite journal |vauthors=Maida I, Garcia-Gasco P, Sotgiu G, Rios MJ, Vispo ME, Martin-Carbonero L, Barreiro P, Mura MS, Babudieri S, Albertos S, Garcia-Samaniego J, Soriano V |title=Antiretroviral-associated portal hypertension: a new clinical condition? Prevalence, predictors and outcome |journal=Antivir. Ther. (Lond.) |volume=13 |issue=1 |pages=103–7 |year=2008 |pmid=18389904 |doi= |url=}}</ref><ref name="pmid2398270">{{cite journal |vauthors=Nevens F, Fevery J, Van Steenbergen W, Sciot R, Desmet V, De Groote J |title=Arsenic and non-cirrhotic portal hypertension. A report of eight cases |journal=J. Hepatol. |volume=11 |issue=1 |pages=80–5 |year=1990 |pmid=2398270 |doi= |url=}}</ref><ref name="pmid23420139">{{cite journal |vauthors=Fuss IJ, Friend J, Yang Z, He JP, Hooda L, Boyer J, Xi L, Raffeld M, Kleiner DE, Heller T, Strober W |title=Nodular regenerative hyperplasia in common variable immunodeficiency |journal=J. Clin. Immunol. |volume=33 |issue=4 |pages=748–58 |year=2013 |pmid=23420139 |pmc=3731765 |doi=10.1007/s10875-013-9873-6 |url=}}</ref><ref name="pmid21393872">{{cite journal |vauthors=Vaiphei K, Bhatia A, Sinha SK |title=Liver pathology in collagen vascular disorders highlighting the vascular changes within portal tracts |journal=Indian J Pathol Microbiol |volume=54 |issue=1 |pages=25–31 |year=2011 |pmid=21393872 |doi=10.4103/0377-4929.77319 |url=}}</ref><ref name="pmid18415755">{{cite journal |vauthors=De Boer NK, Tuynman H, Bloemena E, Westerga J, Van Der Peet DL, Mulder CJ, Cuesta MA, Meuwissen SG, Van Nieuwkerk CM, Van Bodegraven AA |title=Histopathology of liver biopsies from a thiopurine-naïve inflammatory bowel disease cohort: prevalence of nodular regenerative hyperplasia |journal=Scand. J. Gastroenterol. |volume=43 |issue=5 |pages=604–8 |year=2008 |pmid=18415755 |doi=10.1080/00365520701800266 |url=}}</ref><ref name="pmid3499813">{{cite journal |vauthors=Sarin SK, Mehra NK, Agarwal A, Malhotra V, Anand BS, Taneja V |title=Familial aggregation in noncirrhotic portal fibrosis: a report of four families |journal=Am. J. Gastroenterol. |volume=82 |issue=11 |pages=1130–3 |year=1987 |pmid=3499813 |doi= |url=}}</ref><ref name="pmid2944377">{{cite journal |vauthors=Imai Y, Minami Y, Miyoshi S, Kawata S, Saito R, Noda S, Tamura S, Nishikawa M, Tajima K, Tarui S |title=Idiopathic portal hypertension associated with Hashimoto's disease: report of three cases |journal=Am. J. Gastroenterol. |volume=81 |issue=9 |pages=791–5 |year=1986 |pmid=2944377 |doi= |url=}}</ref><ref name="pmid24155091">{{cite journal |vauthors=Siramolpiwat S, Seijo S, Miquel R, Berzigotti A, Garcia-Criado A, Darnell A, Turon F, Hernandez-Gea V, Bosch J, Garcia-Pagán JC |title=Idiopathic portal hypertension: natural history and long-term outcome |journal=Hepatology |volume=59 |issue=6 |pages=2276–85 |year=2014 |pmid=24155091 |doi=10.1002/hep.26904 |url=}}</ref><ref name="pmid19101627">{{cite journal |vauthors=de Lonlay P, Seta N |title=The clinical spectrum of phosphomannose isomerase deficiency, with an evaluation of mannose treatment for CDG-Ib |journal=Biochim. Biophys. Acta |volume=1792 |issue=9 |pages=841–3 |year=2009 |pmid=19101627 |doi=10.1016/j.bbadis.2008.11.012 |url=}}</ref><ref name="pmid1438671">{{cite journal |vauthors=Allison MC, Mowat A, McCruden EA, McGregor E, Burt AD, Briggs JD, Junor BJ, Follett EA, MacSween RN, Mills PR |title=The spectrum of chronic liver disease in renal transplant recipients |journal=Q. J. Med. |volume=83 |issue=301 |pages=355–67 |year=1992 |pmid=1438671 |doi= |url=}}</ref><ref name="pmid8020909">{{cite journal |vauthors=Gane E, Portmann B, Saxena R, Wong P, Ramage J, Williams R |title=Nodular regenerative hyperplasia of the liver graft after liver transplantation |journal=Hepatology |volume=20 |issue=1 Pt 1 |pages=88–94 |year=1994 |pmid=8020909 |doi= |url=}}</ref><ref name="pmid17504943">{{cite journal |vauthors=Vernier-Massouille G, Cosnes J, Lemann M, Marteau P, Reinisch W, Laharie D, Cadiot G, Bouhnik Y, De Vos M, Boureille A, Duclos B, Seksik P, Mary JY, Colombel JF |title=Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine |journal=Gut |volume=56 |issue=10 |pages=1404–9 |year=2007 |pmid=17504943 |pmc=2000290 |doi=10.1136/gut.2006.114363 |url=}}</ref><ref name="pmid21272804">{{cite journal |vauthors=Calabrese E, Hanauer SB |title=Assessment of non-cirrhotic portal hypertension associated with thiopurine therapy in inflammatory bowel disease |journal=J Crohns Colitis |volume=5 |issue=1 |pages=48–53 |year=2011 |pmid=21272804 |doi=10.1016/j.crohns.2010.08.007 |url=}}</ref><ref name="pmid23121401">{{cite journal |vauthors=Roulot D |title=Liver involvement in Turner syndrome |journal=Liver Int. |volume=33 |issue=1 |pages=24–30 |year=2013 |pmid=23121401 |doi=10.1111/liv.12007 |url=}}</ref><ref name="pmid2019375">{{cite journal |vauthors=Geubel AP, De Galocsy C, Alves N, Rahier J, Dive C |title=Liver damage caused by therapeutic vitamin A administration: estimate of dose-related toxicity in 41 cases |journal=Gastroenterology |volume=100 |issue=6 |pages=1701–9 |year=1991 |pmid=2019375 |doi= |url=}}</ref>
===Cirrhotic causes===
===Cirrhotic causes===
*Chronic hepatitis (B or C)
*[[Chronic hepatitis]] ([[Hepatitis B|B]] or [[Hepatitis C|C]])


===Non-cirrhotic causes===
===Non-cirrhotic causes===
'''Prehepatic causes'''
'''Pre-hepatic causes'''
*Portal vein thrombosis
*[[Portal vein thrombosis]]
*Splenic vein thrombosis
*[[Splenic vein thrombosis]]
*Splanchnic arteriovenous fistula
*[[Splanchnic]] [[arteriovenous fistula]]
*Splenomegaly (eg, from lymphoma, Gaucher's disease*)
*[[Splenomegaly]] (eg, from [[lymphoma]], [[Gaucher's disease]])
'''Intrahepatic causes'''
'''Intrahepatic causes'''<ref name="pmid11831999" /><ref name="pmid15832360" /><ref name="pmid18389904" /><ref name="pmid2398270" /><ref name="pmid23420139" /><ref name="pmid21393872" /><ref name="pmid18415755" /><ref name="pmid3499813" /><ref name="pmid2944377" /><ref name="pmid24155091" /><ref name="pmid19101627" /><ref name="pmid17504943" /><ref name="pmid21272804" /><ref name="pmid23121401" /><ref name="pmid2019375" />
*Presinusoidal:
*Presinusoidal:
**Schistosomiasis
**[[Schistosomiasis]]
**Idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia)
**Idiopathic non-[[Cirrhosis|cirrhotic]] [[portal hypertension]] (including nodular regenerative [[hyperplasia]])
**Primary biliary cholangitis
**[[Primary biliary cirrhosis]]
**Sarcoidosis*
**[[Sarcoidosis]]
**Congenital hepatic fibrosis
**[[Congenital hepatic fibrosis]]
**Primary sclerosing cholangitis
**[[Primary sclerosing cholangitis]]
**Hepatic arteriopetal fistula
**[[Hepatic]] arteriopetal [[fistula]]
**Adult polycystic liver disease
**Adult [[polycystic liver disease]]
**Arteriovenous fistulas
**[[Arteriovenous fistula|Arteriovenous fistulas]]
**Autoimmune cholangiopathy
**[[Autoimmune]] cholangiopathy
**Vinyl chloride toxicity
**[[Vinyl chloride]] toxicity
**Neoplastic occlusion of the intrahepatic portal vein
**[[Neoplastic]] occlusion of the intra-[[hepatic]] [[portal vein]]
**Mineral oil granuloma*
**Mineral oil [[granuloma]]
*Sinusoidal:
*Sinusoidal:
**Arsenic poisoning
**[[Arsenic]] poisoning
**Vinyl chloride toxicity
**[[Vinyl chloride]] toxicity
**Drugs (eg, amiodarone, methotrexate)
**Drugs (eg, [[amiodarone]], [[methotrexate]])
**Alcoholic liver disease*
**[[Alcoholic liver disease]]
**Nonalcoholic fatty liver disease
**[[Non-alcoholic fatty liver disease|Nonalcoholic fatty liver disease]]
**Gaucher's disease*
**[[Gaucher's disease]]
**Zellweger syndrome
**[[Zellweger syndrome]]
**Viral hepatitis
**[[Viral hepatitis]]
**Chronic Q fever
**[[Q fever|Chronic Q fever]]
**Schistosomiasis*
**[[Schistosomiasis]]
**Amyloid or light-chain deposition in the space of Disse
**[[Amyloid]] or light-chain deposition in the [[space of Disse]]
**Acute hepatic injury
**Acute [[hepatic]] injury
**Mastocytosis
**[[Mastocytosis]]
**Agnogenic myeloid metaplasia
**Agnogenic [[myeloid]] [[metaplasia]]
**Acute fatty liver of pregnancy
**[[Acute fatty liver of pregnancy]]
*Postsinusoidal:
*Postsinusoidal:
**Sinusoidal obstruction syndrome (venoocclusive disease)
**[[Sinusoidal obstruction syndrome]] ([[Veno-occlusive disease|venoocclusive disease]])
**Budd-Chiari syndrome
**[[Budd-Chiari syndrome]]
**Alcoholic liver disease*
**[[Alcoholic liver disease]]
**Chronic radiation injury
**Chronic [[radiation]] injury
**Vitamin A toxicity
**[[Vitamin A]] toxicity
**Epithelioid hemangioendothelioma
**Epithelioid hemangioendothelioma
**Angiosarcoma
**[[Angiosarcoma]]
**Sarcoidosis
**[[Sarcoidosis]]
**Mycobacterium avium or M. intracellulare infection
**[[Mycobacterium avium complex|Mycobacterium avium]] or [[Mycobacterium intracellulare|M. intracellulare]] infection
**Mineral oil granuloma
**Mineral oil [[granuloma]]
*Posthepatic:
'''Post-hepatic:'''<ref name="pmid17558079" /><ref name="pmid18685811" />
**Inferior vena cava (IVC) obstruction (eg, Budd-Chiari syndrome*)
*[[Inferior vena cava]] (IVC) obstruction (eg, [[Budd-Chiari syndrome]])
**Cardiac disease (constrictive pericarditis, restrictive cardiomyopathy)
*[[Cardiac]] disease ([[constrictive pericarditis]], [[restrictive cardiomyopathy]])
==References==
{{reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 20:00, 8 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Causes of gastointestinal varices include all the causes of increased portal venous pressure, which may be divided into cirrhotic and non-cirrhotic causes.

Causes

Cirrhotic causes

Non-cirrhotic causes

Pre-hepatic causes

Intrahepatic causes[1][5][6][7][8][9][10][11][12][13][14][17][18][19][20]

Post-hepatic:[3][4]

References

  1. ↑ 1.0 1.1 Li X, Gao W, Chen J, Tang W (2000). "[Non-cirrhotic portal hypertension associated with autoimmune disease]". Zhonghua Wai Ke Za Zhi (in Chinese). 38 (2): 101–3. PMID 11831999.
  2. ↑ Kono K, Ohnishi K, Omata M, Saito M, Nakayama T, Hatano H, Nakajima Y, Sugita S, Okuda K (1988). "Experimental portal fibrosis produced by intraportal injection of killed nonpathogenic Escherichia coli in rabbits". Gastroenterology. 94 (3): 787–96. PMID 3276575.
  3. ↑ 3.0 3.1 Kumar S, Joshi R, Jain AP (2007). "Portal hypertension associated with sickle cell disease". Indian J Gastroenterol. 26 (2): 94. PMID 17558079.
  4. ↑ 4.0 4.1 Bayan K, Tüzün Y, Yilmaz S, Canoruc N, Dursun M (2009). "Analysis of inherited thrombophilic mutations and natural anticoagulant deficiency in patients with idiopathic portal hypertension". J. Thromb. Thrombolysis. 28 (1): 57–62. doi:10.1007/s11239-008-0244-8. PMID 18685811.
  5. ↑ 5.0 5.1 Girard M, Amiel J, Fabre M, Pariente D, Lyonnet S, Jacquemin E (2005). "Adams-Oliver syndrome and hepatoportal sclerosis: occasional association or common mechanism?". Am. J. Med. Genet. A. 135 (2): 186–9. doi:10.1002/ajmg.a.30724. PMID 15832360.
  6. ↑ 6.0 6.1 Maida I, Garcia-Gasco P, Sotgiu G, Rios MJ, Vispo ME, Martin-Carbonero L, Barreiro P, Mura MS, Babudieri S, Albertos S, Garcia-Samaniego J, Soriano V (2008). "Antiretroviral-associated portal hypertension: a new clinical condition? Prevalence, predictors and outcome". Antivir. Ther. (Lond.). 13 (1): 103–7. PMID 18389904.
  7. ↑ 7.0 7.1 Nevens F, Fevery J, Van Steenbergen W, Sciot R, Desmet V, De Groote J (1990). "Arsenic and non-cirrhotic portal hypertension. A report of eight cases". J. Hepatol. 11 (1): 80–5. PMID 2398270.
  8. ↑ 8.0 8.1 Fuss IJ, Friend J, Yang Z, He JP, Hooda L, Boyer J, Xi L, Raffeld M, Kleiner DE, Heller T, Strober W (2013). "Nodular regenerative hyperplasia in common variable immunodeficiency". J. Clin. Immunol. 33 (4): 748–58. doi:10.1007/s10875-013-9873-6. PMC 3731765. PMID 23420139.
  9. ↑ 9.0 9.1 Vaiphei K, Bhatia A, Sinha SK (2011). "Liver pathology in collagen vascular disorders highlighting the vascular changes within portal tracts". Indian J Pathol Microbiol. 54 (1): 25–31. doi:10.4103/0377-4929.77319. PMID 21393872.
  10. ↑ 10.0 10.1 De Boer NK, Tuynman H, Bloemena E, Westerga J, Van Der Peet DL, Mulder CJ, Cuesta MA, Meuwissen SG, Van Nieuwkerk CM, Van Bodegraven AA (2008). "Histopathology of liver biopsies from a thiopurine-naïve inflammatory bowel disease cohort: prevalence of nodular regenerative hyperplasia". Scand. J. Gastroenterol. 43 (5): 604–8. doi:10.1080/00365520701800266. PMID 18415755.
  11. ↑ 11.0 11.1 Sarin SK, Mehra NK, Agarwal A, Malhotra V, Anand BS, Taneja V (1987). "Familial aggregation in noncirrhotic portal fibrosis: a report of four families". Am. J. Gastroenterol. 82 (11): 1130–3. PMID 3499813.
  12. ↑ 12.0 12.1 Imai Y, Minami Y, Miyoshi S, Kawata S, Saito R, Noda S, Tamura S, Nishikawa M, Tajima K, Tarui S (1986). "Idiopathic portal hypertension associated with Hashimoto's disease: report of three cases". Am. J. Gastroenterol. 81 (9): 791–5. PMID 2944377.
  13. ↑ 13.0 13.1 Siramolpiwat S, Seijo S, Miquel R, Berzigotti A, Garcia-Criado A, Darnell A, Turon F, Hernandez-Gea V, Bosch J, Garcia-Pagán JC (2014). "Idiopathic portal hypertension: natural history and long-term outcome". Hepatology. 59 (6): 2276–85. doi:10.1002/hep.26904. PMID 24155091.
  14. ↑ 14.0 14.1 de Lonlay P, Seta N (2009). "The clinical spectrum of phosphomannose isomerase deficiency, with an evaluation of mannose treatment for CDG-Ib". Biochim. Biophys. Acta. 1792 (9): 841–3. doi:10.1016/j.bbadis.2008.11.012. PMID 19101627.
  15. ↑ Allison MC, Mowat A, McCruden EA, McGregor E, Burt AD, Briggs JD, Junor BJ, Follett EA, MacSween RN, Mills PR (1992). "The spectrum of chronic liver disease in renal transplant recipients". Q. J. Med. 83 (301): 355–67. PMID 1438671.
  16. ↑ Gane E, Portmann B, Saxena R, Wong P, Ramage J, Williams R (1994). "Nodular regenerative hyperplasia of the liver graft after liver transplantation". Hepatology. 20 (1 Pt 1): 88–94. PMID 8020909.
  17. ↑ 17.0 17.1 Vernier-Massouille G, Cosnes J, Lemann M, Marteau P, Reinisch W, Laharie D, Cadiot G, Bouhnik Y, De Vos M, Boureille A, Duclos B, Seksik P, Mary JY, Colombel JF (2007). "Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine". Gut. 56 (10): 1404–9. doi:10.1136/gut.2006.114363. PMC 2000290. PMID 17504943.
  18. ↑ 18.0 18.1 Calabrese E, Hanauer SB (2011). "Assessment of non-cirrhotic portal hypertension associated with thiopurine therapy in inflammatory bowel disease". J Crohns Colitis. 5 (1): 48–53. doi:10.1016/j.crohns.2010.08.007. PMID 21272804.
  19. ↑ 19.0 19.1 Roulot D (2013). "Liver involvement in Turner syndrome". Liver Int. 33 (1): 24–30. doi:10.1111/liv.12007. PMID 23121401.
  20. ↑ 20.0 20.1 Geubel AP, De Galocsy C, Alves N, Rahier J, Dive C (1991). "Liver damage caused by therapeutic vitamin A administration: estimate of dose-related toxicity in 41 cases". Gastroenterology. 100 (6): 1701–9. PMID 2019375.

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