Portal hypertensive gastric disease has many synonyms, namely, congestive gastric disease, pressure gastritis, portal hypertensive gastritis, acute congestion of gastric mucosa, hemorrhagic gastritis, erosive gastritis, etc. the occurrence of portal hypertensive gastric disease is related to hepatic disease which causes portal hypertension, decrease of liver function, lowering of albumin content, endotoxemia and hypergastrinemia. When portal hypertension exists, there is obstruction of venous blood return, increase of mucosal capillary dydrostatic pressure, increase of permeability, loss of large amount of plasmic substances through perfusion and the submucosa shows generalized edema. The gastric mucosal damage pathologic process is evoked; there is disturbance in metabolic interchange of oxygen and nutritious substances; the gastric mucosal tissues are vulnerable to injury, may degenerate and become necrotic.
The chief clinical manifestations of portal hypertensive gastric disease are chronic gastritis and repeated acute hemorrhage of gastric mucosa. Therefore, besides symptoms of gastric disease, if there is concealed or prolonged chronic upper digestive tract hemorrhage, the patient may have marked symptoms and signs of anemia. Active treatment for primary liver disease means early systemic TCM therapy and the latter may lead to clinical cure of Hepatophilic virus disease. The results are quick improvement of liver function, decrease of coagulative disturbances, lowering of portal hypertension, prevention of profuse hematemesis due to portal hypertension and decrease of the incidence of hematochezia. All these are important in the prevention and treatment of hepatogenic peptic ulcer and portal hypertensive gastric disease and in the avoidance of profuse hemorrhage of upper digestive tract.
If symptoms of hematemesis and hematochezia have occurred, it is necessary to rule out chronic virus hepatitis and to institute systemic TCM treatment because if the primary cause is not abolished, it is possible that the second and third time hemorrhage may occur.
Recently, in clinical practice, we find that the age of patients with gastric disease complicated with hemorrhage is becoming younger. It is worthwhile to detect early and to pay enough attention to children with virus hepatitis and give them TCM treatment.
Introduction of cases (continued)
| Case 3
Cheung (code number 2087), female, 73 years of age. Her son is a type B hepatitis virus carrier. The patient had a history of hemorrhoids complicated with hemorrhage. In recent years, she had repeated upper abdominal pain which required emergent hospitalization. EKG examination showed normal result; X-ray gastrointestinal barium meal examination revealed polyps (息肉) which required endoscopic operation (內規鏡手術). But after operation, the upper abdominal pain occurred as usual. On February 2000, she was hospitalized and given conservative treatment because of tarry stool (黑便) and profuse vomiting. She received three pounds of blood and also gastroscopic examination and was told that she had duodenal ulcer (十二指腸潰瘍). She continued to be treated by western medication. Physical examination revealed and old lean woman with an enlarged aple tongue, (++) pitting edema of lower extremities. The veins of her abdominal wall and lower extremities were prominent. The liver was 1.5 cm below costal margin with percussion tenderness. After 3 parcels of TCM drugs, she felt good without any discomfort and the liver retracted to 1.5 cm above costal margin. She slept well and the edema decrease. Another 3 parcels of TCM drugs were administered and although there was abdominal pain after taking the medicine and there were wetness-heat stools, being twice a day and large in amount, she felt marked improvement in appetite. There was drawing pain at the back of the knee joint and (+_) pitting edema of the lower limbs. When she had taken 9 parcels of TCM medication, she felt no discomfort and no pain of the back of knee joint while walking. The edema of lower extremities disappeared and the oral ulcers and left upper lip vesicles were no more seen. Systemic TCM therapy for four weeks lead to clinical cure of the disease and medication was stopped for observation. She also said that her senile plagues became less and lighter in color; her appetite was good and she had no more abdominal pain. She had a return visit one month after cessation of TCM medication and she experienced slight abdominal distention and vague upper abdominal pain. The stools were smooth and formed, being 1-2 times a day and yellow in color. No pain was felt at the shoulder joint and back of knee joint. Physical examination revealed tympanites (鼓腸), a normal liver and lower extremities with no marked edema. These symptoms disappeared after 5 parcels of TCM medication. |
| Case 4
Liu (code number 267) 67 years of age. The patient began to have nausea and vomiting during teeth brushing, distention of abdomen, belching, borborygmus, wetness-heat stools and tenesmus at the age of twenty or more and it needed long time gastric drug administration. Ten more yars before, the patient had hemorrhoids and repeated occult blood in the stools. In 1984, surgical operation was performed because of gastric hemorrhage but during operation, no peptic ulcer of the stomache or duodenum was found so that only neurotripsy (神經壓軋術) of the diaphragmatic nerve (膈神經) was done. Hypertension was found ten years ago and some time after, the patient had glaucoma, hyperlipemia and obstinate thick white coating of the tongue. The patient’s first visit was on October 1995, complaining repeated stomache ache, nausea, wetness-heat of stools, tenesmus (里急後重), scanty stools, flatus, poor appetite, nocturia (夜尿多), mild vertigo and cloudiness of mind. Physical examination: senile appearance, lean, local thick white coating at right posterior part of tongue, abdomen distended and full with a frog like shape, liver 4.5 cm above costal margin with percussion tenderness, (++) pitting edema of lower extremities. The tentative diagnosis was portal hypertensive gastric disease, virus gastrointestinal disease, hepatic anemia, hypertension, decrease size of liver to be investigated. Through repeated TCM treatment, the size of liver returned to normal, tongue coating and gastric discomfort disappeared. Clinical cure was obtained but occasionally TCM medication was required.
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By Wong Kwok Hung
published on 27th March 2001
(translated by Professor ZHENG Hua En in September 2002)