Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients

Abstract

AIM:To assess the prevalence of portal hypertension (PH) related colorectal lesions in liver transplant candidates, and to evaluate its association with the severity of PH. METHODS:Between October 2004 and December 2005, colonoscopy was performed in 92 cirrhotic liver transplant candidates. We described the lesions resulting from colorectal PH and their association with the grade of PH in 77 patients who underwent measurement of hepatic venous pressure gradient (HVPG). RESULTS:Mean age was 55 years and 80.7% of patients were men. The main etiology of cirrhosis was alcoholism (45.5%). Portal hypertensive colopathy (PHC) was found in 23.9%, colonic varices in 7.6% and polyps in 38% of patients (adenomatous type 65.2%). One asymptomatic patient had a well-differentiated adenocarcinoma. The manifestations of colorectal PH were not associated with the etiology of liver disease or with the Child-Pugh grade. Ninety percent of patients with colopathy presented with gastroesophageal varices (GEV), and 27.5% of patients with GEV presented with colopathy (P = 0.12). A relationship between higher values of HVPG and presence of colopathy was observed (19.9 ± 6.2 mmHg vs 16.8 ± 5.4 mmHg, P = 0.045), but not with the grade of colopathy (P = 0.13). Preneoplastic polyps and neoplasm (P = 0.02) and spontaneous bacterial peritonitis (P = 0.006) were more prevalent in patients with colopathy. We did not observe any association between previous β-blocker therapy and the presence of colorectal portal hypertensive vasculopathy. CONCLUSION:PHC is common in cirrhotic liver transplant candidates and is associated with higher portal pressure.

Prevalence, variability, and outcomes in portal hypertensive colopathy: a study in patients with cirrhosis and paired controls

“…PHC has been associated with more severe liver disease by Child-Pugh score, 22 low platelet counts, 22 large esophageal varices, 4 portal pressure. 8 However, other studies have not reported an association between PHC and Child-Pugh severity score, 6 portal pressure, 23 or gastroesophageal varices. 24 In the present study, we did not observe a statistical association between PHC and severity of liver disease, measured by Child-Pugh 11 and Model for end-stage liver disease scores 12 or liver stiffness measurement (Fig.…”

“…6 Controversial results have been described concerning the relationship of this condition with the severity of liver disease. 7,8 The diagnostic criteria, prevalence, and management of portal hypertension-related outcomes in the upper GI tract are well-established. 9 However, the management of PHC has been challenged by its variability in diagnostic criteria and controversial results on prevalence and clinical relevance of this condition.…”

Improvement of Schistosomal Portal Hypertensive Colopathy After Surgical Treatment

“…They both have a colitis-like lesion with vascular abnormalities and this lesions are more severe in portal hypertension (4,9,14) . In our study, all patients had previous digestive bleeding and presented mild to moderate mononuclear inflammatory infiltration, hyperemia and capillary ectasia in histopathological evaluation.…”

“…It may cause lower gastrointestinal bleeding or unidentified chronic anemia in patients with severe portal hypertension (4,11,14) . Splenectomy and gastric devascularization, one of the recommended surgical treatments for gastrointestinal bleeding in patients with hepatosplenic schistosomiasis, reduces portal pressure by around 30%, as also the blood flow to the territory of the esophageal varices while preserving liver function (3,5,6,12,16) .…”

Portal Hypertensive Gastropathy and Colopathy

“…62 PHC has been reported to be associated with a lower platelet count, 6 an increasing severity of cirrhosis (Child grade), 6 large esophageal varices, 70 gastric varices, 64,69 higher portal pressure, 70,71 and spontaneous bacterial peritonitis. 71 However, some studies have reported no correlation of PHC or colorectal varices with the severity of cirrhosis (Child grade), 65,71,72 portal pressure, 67,73 or gastroesophageal varices. 65,68,69,72 …”