Portal hypertensive colopathy in Egyptian cirrhotic patients: an endoscopic study

Abstract

Background Hepatitis C virus (HCV) infection is a major health problem in Egypt. It is often complicated by liver cirrhosis and portal hypertension, resulting in gastroesophageal varices, gastropathy, and colopathy. However, there is still lack of data with respect to the prevalence and clinical relevance of colopathy in this kind of liver disease. The aim of this study was to determine the prevalence of colopathic lesions in HCV-related cirrhotic patients, and to study their associations with the severity of liver disease and manifestations of portal hypertension Patients and methods This cross-sectional study included 60 patients with liver cirrhosis who were submitted to thorough clinical, laboratory, and ultrasonographic examinations. In addition, both upper and lower gastrointestinal endoscopy were performed to detect portal hypertensive complications including colopathic lesions. According to their severity, colopathic lesions were graded into three grades. Patients with higher colopathic grading (grade 2 and 3) were compared with the remaining participants with respect to the severity of the liver disease and other manifestations of portal hypertension. Results The prevalence of colopathy in cirrhotic patients with underlying HCV etiology was 91%. Patients with higher grades of colopathy were characterized by more severe liver disease. Moreover, they had increased frequency of both esophageal and gastric varices, and prior sclerotherapy or band ligation, as well as more collaterals and gastropathy, and higher grades of esophageal varices. Conclusion Colopathic lesions are frequent in patients with HCV-induced cirrhosis. Getting endoscopic treatment for varices is a risk factor for developing higher grades of colopathy. The latter could be considered as a marker of a worse prognosis in patients with HCV cirrhosis.

The Correlation of Upper and Lower Endoscopic Changes in Patients with Liver Cirrhosis and Portal Hypertension

“…Regarding coagulation, liver and kidney function results, Shalaby et al [15] The study by Abd-Elsalam et al [16] found that the means albumin level was 3.16±0.63, mean bilirubin level was 2.18±2.1, and the mean INR was 1.42±0.43, these results were comparable to our findings.…”

“…In the current study, the age ranged from 55 to 77 years with a mean age ±SD was 68.50± 6.61 years, with male sex predominance [72% were males]. Shalaby et al [15] studied portal hypertensive colopathy in Egyptian cirrhotic patients. They performed a cross-sectional study with the inclusion of 60 patients with liver cirrhosis.…”

“…The mean platelets count was 78.34± 12.09x10 9 /L. Shalaby et al [15] reported higher mean hemoglobin [11.57±1.86 g/dl], and mean platelet count [87.68±42.71x10 9 /L]. The cause of the difference may be due to the variation of the studied age groups, and different sample size.…”

“…In line with these results, Salama et al [17] reported that the presence of colonic hyperemia significantly correlated with the presence of gastroesophageal varices, whereas the presence of hemorrhoids, rectal varices and angiodysplasia did not correlate with the presence of gastroesophageal varices. In addition, Shalaby et al [15] reported that there was no significant relation between gastric varices and portal hypertensive colopathy grade. In addition, Bresci et al [22] detected that one of these colonic mucosal abnormalities significantly correlated with the presence of gastroesophageal varices and PHG.…”

“…The mean PV was 12.26±2.75mm. Shalaby et al [15] revealed that [28.3%] of patients had mild ascites, [35%] of patients had moderate ascites, [15%] of patients had marked ascites and [21.6%] had absent ascites. All patients had coarse liver echo pattern and attenuated hepatic vein.…”