UMass Memorial Medical Center Worcester, Massachusetts
Introduction: Portal hypertension polyposis (PHP) is a condition encountered in advanced liver disease and cirrhosis, characterized by the presence of gastroduodenal polyps and portal hypertension. There are few studies regarding the natural course and prognosis of PHP, in particular in the United States. In one international, retrospective study, PHP was found to be common in patients with advanced fibrosis and was associated with thrombocytopenia, Child-Pugh score >6, MELD score >16, and previous band ligation. However, further studies are needed to understand the clinical implications of PHP in this patient population, including effects on prognosis, and short and long-term outcomes.
Methods: We conducted a retrospective study of 122 patients with PHP between 2008-2019 at a single, academic referral center. PHP was defined as the presence of 1 or more gastroduodenal polyps with either endoscopic, radiographic, or clinical evidence of portal hypertension. Inclusion criteria included patients over 18-years-of-age who underwent upper endoscopy between 2008-2019 with PHP. Exclusion criteria included patients < 18-years-of-age. Clinical and demographic data, including etiology of liver disease, MELD score, complications of cirrhosis, hospitalizations, and mortality, were collected from review of electronic health records (EHR).
Results: In total, 122 patients met the inclusion criteria. The average age was 59.07 +/- 10.67 (range: 21-91) comprising 90 male patients (67.61%). Complications of cirrhosis in this patient population were common and included ascites (80%), splenomegaly (72%), hepatic encephalopathy (56%), and gastroesophageal varices (56%). The most common etiologies of cirrhosis were alcohol (57.25%) and NASH (22.14%) (Table 1). At the time of diagnosis, the mean MELD score was 15, mean hemoglobin count 10.9 g/dL (SD = 2.45), and mean creatinine 1.23 mg/dL (SD = 1.24). The average number of hospitalizations since diagnosis of PHP was 4. The overall mortality rate was 32%.
Discussion: Despite the scarcity of studies in the literature, PHP appears to be a common finding in patients with cirrhosis. In this large, retrospective cohort, patients with PHP had moderate MELD scores, with a high rate of complications and mortality. Further studies are needed to determine the prognosis and clinical implications of PHP.
