Alterations in colonic mucosal lesions in patients with portal hypertension

Abstract 

Background and study aims

Portal hypertensive colopathy (PHC) is a clinical entity in liver cirrhosis. The frequency and profile of colonic mucosal lesions of this entity are not well studied. The aim of this study is to evaluate the prevalence of colonic mucosal changes in patients with liver cirrhosis and their clinical significance.

Patients and methods

Forty patients with post-viral liver cirrhosis and portal hypertension (PHT) underwent upper gastrointestinal endoscopy as well as a full length colonoscopy to detect changes in colonic mucosa. PHC was diagnosed endoscopically by the presence of vascular ectasia, diffuse hyperaemic mucosa and rectal varices. Biopsies were obtained from the recto-sigmoid area as well as from any abnormal mucosal lesions apart from angiodysplastic areas.

Results

Diffuse hyperaemia, angiodysplasia and rectal varices were found in 40%, 32.5% and 17.5% of patients while haemorrhoids in 42.5%, respectively. The prevalence of PHC increased with worsening Child-Pugh class, the mere presence of oesophageal varices while platelet count was significantly associated with angiodysplastic lesions only. None of other upper endoscopic features of PHT was significantly related to PHC. Moreover, history of lower gastrointestinal (GI) bleeding was significantly associated with the presence of rectal varices and haemorrhoids. Colonoscopic features of PHC were significantly associated with the histopathological diagnosis revealing 79% sensitivity and 66.6% specificity.

Conclusion

PHC is a frequent finding in patients with PHT. Colonoscopic features suggestive of PHC were in concordance with the histopathological evidence. Although the presence of haemorrhoids is not a feature of colopathy, yet it should be considered together with anorectal varices as a cause of lower GI bleeding.

Abbreviations: PHT, portal hypertension, PHC, portal hypertensive colopathy, GI, gastrointestinal, AST, aspartate transaminase, ALT, alanine transaminase, INR, international normalized ratio, GEV-1, gastro-oesophageal varices type1, GEV-2, gastro-oesophageal varices type2, IGV-1, isolated gastric varix type 1, IGV-2, isolated gastric varix type 2, PHG, portal hypertensive gastropathy, PPV, positive predictive value, NPV, negative predictive value

Keywords: Portal hypertension, Colopathy