Mucosal abnormalities of the colon in patients with portal hypertension: An endoscopic study

• Published in: Gastrointestinal endoscopy 2000-10, Vol.52 (4), p.511-516
• Main Authors: Bini, Edmund J., Lascarides, Chris E., Micale, Philip L., Weinshel, Elizabeth H.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Colon - pathology; Colonic Diseases - complications; Colonic Diseases - diagnosis; Colonoscopy; Digestive system. Abdomen; Endoscopy; Female; Humans; Hypertension, Portal - complications; Hypertension, Portal - pathology; Intestinal Mucosa - pathology; Investigative techniques, diagnostic techniques (general aspects); Liver Cirrhosis - complications; Male; Medical sciences; Multivariate Analysis; Retrospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2000.108478

Background: Controversy still exists regarding colonic mucosal abnormalities in patients with portal hypertension (portal colopathy). The aims of this study were to better define portal colopathy and to identify risk factors for these colonic mucosal abnormalities. Methods: We reviewed the medical records of 437 patients with cirrhosis and portal hypertension and 224 with irritable bowel syndrome (control patients) who underwent colonoscopy over a 6-year period. Results: Individuals with portal hypertension were significantly more likely than control patients to have colitis-like abnormalities (38% vs. 3%, p < 0.001) and vascular lesions (13% vs. 3%, p < 0.001). In the multivariate model, portal hypertensive gastropathy (odds ratio 5.64: 95% CI [3.39, 9.41]; p < 0.001), 2+ or larger esophageal varices (odds ratio 4.76: 95% CI [2.78, 8.15]; p < 0.001), and Child-Pugh class C cirrhosis (odds ratio 2.64: 95% CI [1.40, 4.97]; p = 0.003) were independently associated with an increased risk of having portal colopathy, whereas the use of β-blockers independently decreased the risk of having these findings (odds ratio 0.23: 95% CI [0.13, 0.40]; p < 0.001). Mucosal biopsies of the colon in patients with colitis-like abnormalities revealed a mild, nonspecific inflammatory infiltrate with edema and vascular ectasias in the majority of cases. Conclusions: Mucosal abnormalities in portal colopathy include edema, erythema, granularity, friability, and vascular lesions, findings that may be confused with colitis. A standardized grading system to classify the endoscopic appearance and severity of portal colopathy should be adopted. (Gastrointest Endosc 2000;52:511-6.)