874 Original article Intestinal metaplasia in portal hypertensive gastropathy: a frequent pathology Duygu I ˙ bri ¸ sim a , Ug ˘ ur C ¸ evikba ¸ s b , Filiz Akyu ¨z a ,S ¸ule Poturog ˘ lu a , Emel Ahıshalı a , Mine Gu ¨ llu ¨og ˘ lu b , Kadir Demir a , Fatih Be ¸ sı ¸ sık a , Gu ¨ ngo ¨ r Bozta ¸ s a , Sadakat O ¨ zdil a , Yılmaz C ¸ akalog ˘ lu a , Zeynel Mungan a , Atilla O ¨ kten a and Sabahattin Kaymakog ˘ lu a Objective To compare the frequency of intestinal metaplasia (IM) in patients with portal hypertensive gastropathy (PHG) to the control group with functional dyspepsia. Methods Two-hundred and eighty-nine cases were prospectively evaluated in three groups (controls:group I – 123 patients; cirrhotics: group II – 135 patients; noncirrhotic portal hypertensives: group III – 31 patients). Mucosal biopsies (three antrum, one angulus, two corpus) were taken and examined for atrophy, IM, dysplasia, Helicobacter pylori (Hp) and histologic PHG. Results Frequencies of IM in groups I, II and III were 17.1% (type I, 3.3%; type II, 10.6%; type III, 3.3%), 34.3% (type I, 9.6%; type II, 17%; type III, 6.7%) and 33.3% (type I, 9.7%; type II, 12.9%; type III, 9.7%), respectively. In patients with PHG, frequency of IM was significantly higher than in control group (P < 0.05) and correlated with the severity of PHG (P < 0.05). The frequency of type III IM was not statistically different among the three groups. Frequency of atrophy in cirrhotic patients was higher than in control group (17.9% in group I, 32.6% in group II, 25.8% in group III; P < 0.05). In the control group, Hp prevalence was significantly higher than in patients with PHG (P < 0.05) and there was a positive correlation between Hp and atrophy (P < 0.05). In multivariate analysis, PHG and age were found as independent predictors for IM; PHG, age and Hp for atrophy. Conclusion Frequencies of atrophy and IM are higher in patients with PHG. PHG is a reliable marker for IM and atrophy in gastric mucosa. Eur J Gastroenterol Hepatol 20:874–880  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2008, 20:874–880 Keywords: intestinal metaplasia, portal hypertension, portal hypertensive gastropathy Departments of a Gastroenterohepatology and b Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey Correspondence to Duygu I ˙ bri ¸ sim, Sahrayicedit Mah. Halk Sk. 14/7 Kadikoy, 34734 Istanbul, Turkey Tel: + 90 532 377 2139; fax: + 90 216 325 5664; e-mail: duygu@ibrisim.net Received 18 November 2007 Accepted 8 February 2008 Introduction Portal hypertensive gastropathy (PHG) is a common complication of portal hypertension (PHT), occurring in approximately 50–80% of patients. It is the term used to describe the endoscopic appearance of gastric mucosa with a characteristic mosaic-like pattern (MP) with or without red marks (cherry red spots and black-brown spots), seen in patients with cirrhotic and noncirrhotic PHT [1]. The exact pathogenesis of PHG is unknown. Among the pathogenetic factors, local haemodynamic disturbances, imbalance among microcirculatory mediators in gastric mucosa, as well as PHT per se were claimed [2]. The aetiology of characteristic lesions of PHG is not clear; it does not seem to be related to Helicobacter pylori (Hp) infection, and acid secretion does not play an important role. In patients with cirrhosis, prevalence of Hp infection is lower than in the general population [3]. The weakness of the gastric mucosal barrier (reduced epithelial cell integration and a thinner gastric mucous layer) and in some patients, hypergastrinemia-induced acid load are considered to facilitate development of mucosal lesions [4,5]. Intestinal metaplasia (IM) is defined as a potentially reversible change in which a fully differentiated cell type is replaced by another differentiated cell type, and usually represents a change to cells better able to withstand an adverse environment. Thus, IM represents a change from gastric epithelial phenotype to a small intestinal or large intestinal phenotype [6]. As PHG is also a chronic cause of mucosal irritation, it is not surprising that IM develops in the base of PHG. In this study, we aimed to compare the frequency of IM in patients with PHG to a control group with functional dyspepsia. 0954-691X  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0b013e3282fc7380 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.