I had a gasttoscopy and colonoscopy on Friday and receives some disturbing news. However, little background context is in order first. I had an abdominal ultrasound in December and all it said was mild fatty infiltration of the liver. However, I've been having a chronic sore throat for over a month and was worried I had throat or esophageal cancer. So, I took ibuprofen for the pain, and frequently had no more than 5 beers in a day. Yesterday I had a gastroscopy and colonoscopy and, among other things, the report said I had portal gastropathy, which I've read is usually caused by cirrhosis. So, now I'm freaked out, even though the doctor told me after the procedure that things "looked good at the top and bottom". I don't know what to make of things. Any thoughts?
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ToughToes
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Well, portal gastropathy isn't usually the term we see in the US. I believe we would call that portal hypertension. I'd suggest getting a second opinion as that is usually associated with serious fibrosis of the liver. Ultrasound can't really measure that. You need something to measure liver stiffness, typically a FibroScan test. I don't want to freak you out, but you may be facing cirrhosis of the liver due to alcohol. We aren't docs so take that for what it is worth, but my personal experience was misdiagnosis of advancing fibrosis, doc said my liver was fine, but I ended up with cirrhosis. Most primary care docs are useless for diagnosing liver problems before they become an emergency.
The guy who told me my liver was fine was a gastro doc too for whatever that's worth. Ultrasound is most useful looking for cancer but it can't tell you much about stiffness. A good tech can get a sense of the roughness of the surface which is an indirect indication. A large percentage of fibrosis disease isn't identified until a person ends up with stage 4 in the emergency room. I don't know about Canada but until recently docs didn't get paid to look for asymptomatic liver disease. People's responses vary, but 5 beers a day will cause cirrhosis for some. Here are some insights into the incidence of cirrhosis due to alcohol:
1. **National Institute on Alcohol Abuse and Alcoholism (NIAAA)**:
- According to the NIAAA, among all cirrhosis deaths in 2019, approximately 50.3% were alcohol-related. This highlights the significant impact of alcohol consumption on liver health and the development of cirrhosis. [3]
2. **World Health Organization (WHO)**:
- The WHO reports that alcohol consumption significantly contributes to the incidence of liver cirrhosis globally. The organization emphasizes that alcohol is a major risk factor for liver disease, including cirrhosis, and continues to be a leading cause of liver-related morbidity and mortality. [2]
- A study published in this journal estimates that the incidence of alcohol-associated cirrhosis is expected to increase from 1.1 per 100,000 person-years in 2019 to 2.0 per 100,000 person-years by 2040 if current trends in alcohol consumption continue. This projection underscores the growing public health concern related to alcohol use. [4]
4. **Alcohol-Related Emergencies and Deaths in the United States**:
- The NIAAA also notes that more than 178,000 people died from alcohol-related causes in the United States. This statistic includes deaths from liver diseases such as cirrhosis, further emphasizing the severe consequences of excessive alcohol consumption. [1]
I appreciate all your information. But, to be honest, a lot of what you're telling me is causing doubts, which is something I definitely don't need right now. Ok? The last ultrasound also said the liver was normal in size and had a smooth, homogeneous texture. Ok? That doesn't sound like fibrosis or cirrhosis to me. So, no more scary data and negativity, please. Ok?
Sorry, it is scary and can be quite confusing. Most docs get little real education about livers and there is a lot of contradictory information out there. Didn't mean to seem negative but I deal with thousands of patients and the thing that really gets my goat is people who wind up with cirrhosis without warning from their docs and the incidence of disease is increasing rapidly. Just be aware that ultrasound can't diagnose or measure fibrosis. Also, in the disease of steatosis or fatty liver the definition is anything over 5% fat. Ultrasound can't detect fat below about 30%. You reported portal gastrophy which is normally caused by increased pressure at the liver. Perhaps it is caused by something other than fibrosis but it is a condition that needs explanation. Could that diagnosis be in error?
Hepatologists and gastroenterologists both deal with luver issues. Correct. I realize that hepatologists focus specifically on the liver, while GI docs focus on the digestive system as a whole, including the liver. On my last x-sound., the radiologist said "mild fatty infiltration", consistent with steatosis stage 1. That's the minimal level. Correct? As for a diagnostic error, I'm meeting the doctor on August 7. I'll ask him about it then. He called me last night, told me I had nothing to worry about, and when I asked if he thought I had cirrhosis, he emphatically said no. Ok.
Didn't mean to sound argumentative. I got into this world after a gastro doc assured me that my liver was just fine. Four years later I had biopsy proven cirrhosis and no doc had ever told me to be concerned. I advise people to ask lots of questions and become educated themselves. Good luck with your journey. I won't comment further unless you message me directly.
Thanks. I apologize if I sound edgy, but I've been going out of my mind since I read that portal gastropathy crap, so when told me that I've got nothing to worry about last night, and that he didn't think I had cirrhosis, I felt relieved for the first time in two weeks. I guess I just got a bit touchy, because since I now have some hard-fought for peace of kind at long last, i didn't want to regress to ground zero. I figure that the GI Doc know a lot more than I do, and if he isn't worried, neither should I be
Wow! Thanks for all the info. Don't you think ut seems odd and contradictory for the doc to say everything "looked good, top & bottom" as I'm leaving the operating room after the scope. But, on the other hand, say I've got something heavy like PHG?
Oh how I wish I knew what I know now when I was told I had just a fatty liver. Have you had a CT of the abdomen by chance? That should show if you have cirrhosis and/or portal hypertension. A liver biopsy would too which is considered the gold standard in evaluating in someone has cirrhosis or not but I wouldn't go that far right now. Advice that I wish someone would have told me and stressed the importance as I am about to stress to you, my friend, is this: Stop drinking period, even beer, 5 is a lot (never drank at all myself). Lose weight if you're overweight. If you have diabetes, get it under control. Drink coffee!!!! Eat a balanced diet with fruits and vegetables!! Keep blood pressure under control. Personally, I would stop ibuprofen and definitely Tylenol! I have bad knees and I didn't see how on earth I could stop Aleve for the knee pain but I did. I stopped all OTC pain medication for myself. Not an Aleve, Tylenol in 8 years. Exercise, brisk walking at least. Years ago, I was told I had a fatty liver, "you don't drink", so don't worry about it! So I took my doctor's advice and didn't worry about it! Big mistake! Fast forward 7 years, cirrhosis from there, diagnosed in 2018!! Please, please, PLEASE do the things I have mentioned and hopefully you won't develop cirrhosis!! Good luck!!
o also have Cirrhosis. I don’t drink, and it creeped up on me too with just a diagnosis of high liver enzymes and I had a liver biopsy. The docs didn’t seem worried. Now 6 years later I’m diagnosed with PNC, autoimmune problems in my liver,and cirrhosis. I am so worried. The docs told me Tylenol was ok, but not ibuprofen. What do you take for joint pain?? I haven’t had much Tylenol since last November, but I won’t take anymore! I’m doing the things you suggest, only because I have read it would help my cirrhosis and liver issues. The docs haven’t said anything about weight loss, diet, exercise etc. anyone with some encouragement or happy endings stories for me??
P.S. A fibroscan would measure the stiffness of your liver which is another diagnostic test. Anemia? Don't know? Liver enzymes up? Don't know? Get your blood checked.
Thanks for all the info. I last had blood work, as in liver function indicators, done in Nov. All fine. As for a CT scan, or fibroscan, I've had neither. Thanks again.
during an EGD, my liver specialist found that I have portal gastropathy as well. It was described to me as pressure in the stomach with advanced damage to the lining of my stomach related to portal vein hypertension/pressure, related to cirrhosis. The risk is bleeding, of course. Managing the portal vein pressure is key along with changes and diet to limit the further damage to the lining of your stomach. Beta Blockers help with portal vein pressure. I am not a doctor, so please seek your own secondary diagnosis; however, I have this condition and have thoroughly researched it.
Just a note...my GI saw me 4 days prior to being sent (sent me home with GAS-X) to the ER for difficulty breathing and finding out I had decompensated cirrhosis and would need a liver transplant. Not all GIs are looking out for your best interest, beit lack of education on liver disease or apathy. Hetold mesomething else would kill me, not my liver. This was 4 years ago. In April this year, I had a gastric bleed and ended up in the hospital for 12 days. They could not find the bleed location (did anendoscopy and colonoscopy) ,except that there were some gatric polyps that could be the culprit. I looked back on notes from my last endoscopy (done by my GI) , and they DID see the gastric polyps and didn't make an issue of it or say that anythng needed to be done!! My transplant (pre) wants to try and remove the polyps once I am strong enough.
I suggest, as I'm sure you have heard, to see a hepatologist, if possible.
I meant to type hematologist, and I know we don't have one. My town is only about 75,000 population. The closest larger centre where there might be a hematologist is about an hour's drive.
The Ultrasound will be able to tell if your fibrotic or if our cirrhotic but not to what level.
You will see on your ultrasound mention of echogenic texture. Smooth is typical of normal, coarse of Cirrhosis. Then the liver edge, again fatty liver can have mild changes to the edge, while cirrhotic will be nodular.
If you have the ultrasound itself they measure the portal velocity, and size of portal vein. In Fibrosis or Cirrhosis, the Portal will be enlarged with a different pulsisity to the flow.
You can have Portal Hypertension or Gastrophy with out cirrhosis although more rare. And is caused by blood clotting or masses causing blood flow interuption.
On the gastrophy report it should not the size of varacie, and if its upstream or downstream. Down is typically IVC related and is caused by blockages. Up is portal.
Having Gastrophy in the body of the stomach in the absense of Varacies is odd. As it will normally first appear in the esophagus (nearest the start of the blood system coming in)
I would get a second opinion. If your in Canada there are numerous pay for Fibroscan typically 60 to 90 bucks. Go get one.
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