P2050 - Portal Hypertensive Duodenopathy in the Setting of Non-Alcoholic Steatohepatitis: A Case Report

Sarah Singh, MD¹, Ethan M.. Cohen, MD², Mohamed Zitun, MD³, Jennifer Hadam-Veverka, MD^3
1West Virginia University-Camden Clark Medical Center, Parkersburg, WV; ²West Virginia University School of Medicine, Morgantown, WV; ³West Virginia University, Morgantown, WV

Introduction: Portal hypertension is a common complication of chronic liver disease and underlying cirrhosis. This can present with esophageal varices, gastric varices, ascites, or spontaneous bacterial peritonitis. Portal hypertensive duodenopathy (PHD) is a known association of portal hypertension and cirrhosis with an incidence of approximately 8-51%. This wide variance may be secondary to its vast endoscopic presentations including erythema, friable mucosa, and duodenal ulcers or polyps. While this diagnosis is rare, it leads to an increased risk of life-threatening gastrointestinal bleeding. The diagnosis has been well documented in patients with alcohol-induced liver cirrhosis, however, there are no reports on the association between non-alcoholic steatohepatitis (NASH) and PHD.

Case Description/Methods: We present the case of a 57-year-old male with a history of decompensated nonalcoholic fatty liver disease (NAFLD) who came to the emergency department complaining of abdominal pain and maroon and hematochezia. Endoscopic examination revealed signs of portal hypertensive gastropathy as well as congestion and friability in his duodenum, suggestive of PHD. Treatment ranges from medical therapy with beta-blockers for non-bleeding findings to a transjugular intrahepatic portosystemic shunt for active bleeding or refractory cases. Our patient opted for medical therapy.

Discussion: Previous case reports have mentioned PHD in the setting of alcoholic cirrhosis, but not NASH cirrhosis. We present this case to bring awareness to the existence of PHD in the setting of NASH cirrhosis. This is especially prudent considering the rapid increase in the incidence of NAFLD and NASH cirrhosis in the US.



Disclosures:


Sarah Singh, MD¹, Ethan M.. Cohen, MD², Mohamed Zitun, MD³, Jennifer Hadam-Veverka, MD³. P2050 - Portal Hypertensive Duodenopathy in the Setting of Non-Alcoholic Steatohepatitis: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.