**7. Natural history**

PHG may change in an individual patient over time, about 30% of the patients with cirrhosis and mild PHG, progress to severe PHG during a 10 year follow up period, considering that these patients did not receive any prophylactic treatment. Most of the patients with worsening PHG, severe lesions, or *de novo* PHG develop bleeding. There are only a few improved cases in PHG without treatment [27]. Furthermore, Patients who have PHG associated with cirrho‐ sis‐related portal hypertension have more frequently persistent and progressive PHG, which is more likely to bleed than patients with PHG related to non‐cirrhotic portal hypertension [9].

Although, as mentioned above, patients with previous endoscopic therapy (sclerotherapy or endoscopic variceal ligation) have a higher prevalence of PHG, the clinical course of PHG in this context, particularly in non cirrhotic portal hypertension, may be milder and transient [28].

PHG is a dynamic condition emphasized by the observation that 30% of patients who have endoscopic features of PHG remained unchanged throughout follow‐up period, whereas 25% of patients show either worsening or improvement of the condition during the follow up period. Thus, not only can PHG appear for the first time or progress from mild to severe condition over time, but it can also revert from severe to mild, and even disappear completely with treatment [23].
