Gastric red spots in patients with cirrhosis: Subclinical condition of gastric mucosal hemorrhage?

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Abstract
The present study was intended to assess the incidence and the nature of gastric red spots (GRS) in patients with liver cirrhosis. Endoscopically, GRS was more frequently observed in patients with cirrhosis (n = 146) than those without cirrhosis (n = 103) (43.2% vs. 4.8%; P< 0.001). There was no relationship between the incidence of GRS and the severity of cirrhosis or the size of varices. Portal venous pressure was higher in cirrhotics with GRS (n=21) than those without GRS (n=25) (33.7±6.0 mmHg vs. 28.2±4.8 mmHg; P<0.001). Morphometric analysis using the biopsied specimens was made in 16 cirrhotics with GRS, 12 cirrhotics without GRS, and 15 non-cirrhotics. The capillary bed occupation ratio (vascular area/mucosal area) was higher in cirrhotics with GRS (9.3±4.0%) than those without GRS 84.1 ±1.1%) or the non-cirrhotics (3.4±9.8%) (P< 0.005, P< 0.005), while there was no significant differences in the number of capillaries per unit area. Infiltrating inflammatory cell count was similar among the three groups. Extravascular red blood cell count per unit area was higher in cirrhotics with GRS (29.7±31.4) than those without GRS (5.4±5.1) or non-cirrhotics (5.4±6.3) (P< 0.05, P< 0.01). Furthermore, extravasation of red blood cells through defective portion of the endothelium and interposition of red blood cells in interepithelial spaces were observed electron microscopically in cirrhotics with GRS. These results indicate that (a) the nature of GRS in cirrhotics is preexistential capillary ectasia with intramucosal hemorrhage which is caused by high portal pressure and (b) the GRS in cirrhotics might be a subclinical condition of gastric mucosal hemorrhage.