Hemorrhagic gastritis in cirrhotics: A prostaglandin connection?

Cirrhotics with portal hypertension have a high incidence of upper gastrointestinal hemorrhage secondary to diffuse gastritis. Previous studies have identified intrinsic abnormalities in portal hypertensive gastric mucosa, including a decreased ability to generate cytoprotective prostaglandins. This study investigated the effect of operative portal decompression on gastric mucosal prostaglandin generation (PGI₂ and PGE₂) in patients with alcoholic cirrhosis. Findings included: (1) decreased mucosal prostaglandins in unoperated portal hypertensives compared to normal controls and (2) return of mucosal prostaglandin generation to normal following portacaval shunting. In addition, follow-up in 210 survivors of portasystemic shunting demonstrated only six instances of UGI hemorrhage from diffuse gastritis. These results suggest: (1) an association of portal venous pressure with gastric mucosal prostaglandin generation and (2) a possible etiologic role for disturbed prostaglandin synthesis in portal hypertensive hemorrhagic gastritis.