Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

Figueiredo, Pedro; Almeida, Nuno; Lérias, Clotilde; Lopes, Sandra; Gouveia, Hermano; Leitão, Maximino Correia; Freitas, Diniz

doi:10.1007/s10620-007-0111-z

Cited by 52 publications

(53 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The edema of the intestinal lumen had the typical reticulate pattern reported by Figueiredo et al [9] in patients with liver cirrhosis (fig. 2, 3).…”

Section: Discussionsupporting

confidence: 63%

“…They detected villous abnormalities in 14 of these patients, including edema (73%), atrophy (40%) and reddening of the villi (47%), as well as vascular lesions such as angiodysplasia-like abnormalities (67%) and dilated/proliferated vessels (93%). Figueiredo et al [9] reported a significant amount of varices (28%) and areas of mucosa with a reticulate pattern (61%) in 36 patients with portal hypertension examined by capsule endoscopy. Ganc et al [10] examined small intestinal lesions in 9 patients with portal hypertension of schistosomal origin using capsule endoscopy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Small Intestinal Edema Had the Strongest Correlation with Portal Venous Pressure amongst Capsule Endoscopy Findings

Takahashi

Fujimori²,

Narahara³

et al. 2012

Digestion

View full text Add to dashboard Cite

Background/Aim: Previous studies have reported small intestinal lesions in patients with portal hypertensive disease. However, the etiology of these lesions is not clear, as portal venous pressure was not measured in any of these studies. The aim of this study is to clarify the association between small intestinal lesions and hepatic venous pressure gradient (HVPG), which correlates well with portal venous pressure. Methods: Thirty-five patients with liver cirrhosis were evaluated by capsule endoscopy for small intestinal lesions. HVPG was measured within 3 days of capsule endoscopy. Blood tests, clinical symptoms, Child-Pugh classification and HVPG were analyzed against small intestinal lesions such as edemas, red spots, angiodysplasia and varices. Lesions were categorized according to their location in the duodenum, jejunum or ileum. Edema was evaluated using a 4-grade capsule endoscopy scoring index. Results: HVPG and edema scores increased with Child-Pugh scores. Red spots and angiodysplasia did not correlate with HVPG. Varices were detected in only 5 patients. The edema score was the factor which most strongly correlated with HVPG by multivariate analysis (p = 0.0008). There was also a strong linear relation between edema scores and HVPG (R = 0.75, p < 0.0001). Conclusion: Small intestinal edemas showed the strongest correlation with HVPG among all small intestinal lesions.

show abstract

“…The edema of the intestinal lumen had the typical reticulate pattern reported by Figueiredo et al [9] in patients with liver cirrhosis (fig. 2, 3).…”

Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Small Intestinal Edema Had the Strongest Correlation with Portal Venous Pressure amongst Capsule Endoscopy Findings

Takahashi

Fujimori²,

Narahara³

et al. 2012

Digestion

View full text Add to dashboard Cite

show abstract

“…The reported prevalence of PHG varies greatly from 20% to 75% in patients with portal hypertension (Table 1) [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] , and varies greatly from about 35% to 80% in patients with cirrhosis (Table 2) [21, . For example, in a study of 373 cirrhotic patients, 299 (80.2%) had PHG [34] .…”

Section: Epidemiologymentioning

confidence: 99%

“…Itha et al [11] EHPVO in children 163 (12%) Not reported Not reported Rana et al [12] Portal hypertension 41 27 (66%) 19 (46%) 8 (20%) El-Rifai et al [13] Portal hypertension 24 14 (58%) 10 (42%) -moderate 4 (16%) Sogaard et al [14] Portal vein thrombosis 67 28 (42%) Not reported Not reported Figueiredo et al [15] Portal hypertension; cirrhosis 36 27 (75%) 5 (46%) Erden et al [16] Portal hypertension 57 15 (26.3%) Not reported Not reported Duché et al [17] Children, portal hypertension with biliary atresia 125 …”

Section: Not Reported Not Reportedmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

View full text Add to dashboard Cite

AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

show abstract

“…With regard to PHE, the few studies in the literature report a prevalence between 15% and 96.8% in patients with cirrhosis and PHT. However, the number of patients with PHE is probably much higher, with figures between 40% and 96.8% in some series (8)(9)(10)(11)(12)(13)(14)(15). As in the case of PHG, these discrepancies are probably due to differences in the criteria used for patient selection and endoscopic interpretations.…”

Section: Introductionmentioning

confidence: 98%

Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy

et al. 2018

View full text Add to dashboard Cite

show abstract

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

Cited by 52 publications

References 31 publications

Small Intestinal Edema Had the Strongest Correlation with Portal Venous Pressure amongst Capsule Endoscopy Findings

Small Intestinal Edema Had the Strongest Correlation with Portal Venous Pressure amongst Capsule Endoscopy Findings

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy

Contact Info

Product

Resources

About