**3. Epidemiology**

The incidence of PHG varies greatly, it ranges between 20 and 75% of patients with portal hyper‐ tension, of those, approximately 65–90% have mild PHG, whereas 10–25% have severe PHG. This wide discrepancy in results may be attributed to the fact that the study was carried out on different groups of patients; patients with cirrhosis, patients without cirrhosis, patients with dif‐ ferent Child‐Pugh score of liver failure, and lastly patients with history of previous esophageal eradication therapy [7]. It was noticed that higher prevalence of PHG is found in patients with severe portal hypertension, advanced liver disease, and post‐eradication therapy of esophageal varices [8]. Conversely, the incidence of acute gastrointestinal bleeding (hematemesis and/or melena) in PHG patients with cirrhosis were low; reported incidences ranged from 2.5 to 30%, with the greatest occurrences being observed in patients with severe PHG [9].

On the other hand, PHG as a marker of portal hypertension has conflicting results among the studies. Its sensitivity, positive predictive value (PPV) and negative predictive value (NPV), vary considerably between the studies, but its specificity has been reported to be above 95%. Snake‐skin pattern has higher specificity (93–100%) for the diagnosis of PHG [10].

PHG can present at any age, including pediatric or adult patients [7].
