Portal Hypertensive Enteropathy, Occult Bleeding, and Capsule Endoscopy: Where Do We Go from Here?

Dabos, Konstantinos J.; Koulaouzidis, Anastasios

doi:10.1007/s10620-014-3103-9

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…However, on multivariate analysis, only a high CT score was significantly related to PHE in patients with LC and PH. This is probably due to the components of the CT score, which are well-known clinical indicators of PH [ 28 ]. Our result reflects that a proposed new CT scoring system could better select patients who should undergo CE because of the suspected presence of PHE, especially patients with PH and OGIB.…”

Section: Scoring Systemsmentioning

confidence: 99%

Capsule Endoscopy for Portal Hypertensive Enteropathy

Jeon

Kim

2016

Gastroenterology Research and Practice

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Portal hypertensive enteropathy (PHE) is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH) and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE) or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40–70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient's situation, the availability of therapy, and each institutional expertise.

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Section: Scoring Systemsmentioning

confidence: 99%

Capsule Endoscopy for Portal Hypertensive Enteropathy

Jeon

Kim

2016

Gastroenterology Research and Practice

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“…While portal hypertensive gastropathy is easily identified by EGD, capsule endoscopy is needed for the diagnosis of portal hypertensive enteropathy. The characteristic lesions on endoscopy include diffuse mucosal edema and erosion, red spots, vascular tortuosity and increasing number of vessel and angiectasia [12][13][14]. Management of bleeding from portal hypertensive gastroenteropathy can be challenging often because of diffuse bleeding sites.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Tuberculosis Leading to Prehepatic Portal Hypertension: A Case Report

Feng¹

2014

J Cytol Histol

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Tuberculosis can affect any organ or tissue in the abdomen such as gastrointestinal tract, peritoneum, lymphatic system and solid organs. Lymphadenopathy is the most common manifestation of abdominal tuberculosis which can be the only sign of the disease, especially in the periportal region or combined with peritoneal or solid organ involvement. There are a number of causes for prehepatic noncirrhotic portal hypertension, but there were a few reports of prehepatic portal hypertension associated with tuberculosis. Here we report a rare case of intra-abdominal tuberculosis as a cause for portal hypertension and recurrent gastrointestinal bleeding. Enlarged lymph nodes at hepatic hilum compressed the portal vein which caused portal hypertension and portal hypertensive gastropathy and enteropathy. The patient was managed by anti-tuberculosis therapy followed by splenectomy, surgical portaazygous devascularization and splenorenal shunt. In the 2-year followup after operation, the patient was free of symptoms and had cavernous portal vein transformation on CT, and disappearance of varices and portal hypertensive gastroenteropathy on EGDs.

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“…Since the purpose of this study was to assess the balance between the risk of rebleeding and the general health in order to consider the indications for BAE, patients with diseases for which other treatments were preferred over hemostasis with BAE or with insufficient information were excluded. To be more specific, those who met the following criteria were excluded from the study: patients who did not undergo a CT scan within 1 month from CE, and patients without any follow-up information, patients with varix in small bowel, drug-induced enteropathy, Peutz-Jeghers polyp, a history of radiation therapy and portal hypertensive enteropathy ( 15 ). Finally, the remaining patients with SBVLs were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions

et al. 2021

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Background With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. Aim To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Methods We retrospectively analyzed the clinical data of 55 patients with SBVLs among patients with obscure gastrointestinal bleeding. The possible association between the clinical findings and the updated Charlson comorbidity index with rebleeding was evaluated. Results Gastrointestinal rebleeding occurred in 20 patients (36.4%) during the follow-up period. The presence of multiple comorbidities as indicated by an updated Charlson comorbidity index of ! 4 was a risk factor for rebleeding (hazard ratio, 3.64; P = 0.004). Other risk factors were arteriosclerosis of the superior mesenteric artery and multiple SBVLs. Endoscopic hemostasis and the discontinuation of antithrombotic medications were not significantly associated with rebleeding. Patients with a high updated Charlson comorbidity index had a high risk of death of causes other than gastrointestinal rebleeding. Conclusions Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.

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Portal Hypertensive Enteropathy, Occult Bleeding, and Capsule Endoscopy: Where Do We Go from Here?

Cited by 4 publications

References 17 publications

Capsule Endoscopy for Portal Hypertensive Enteropathy

Capsule Endoscopy for Portal Hypertensive Enteropathy

Abdominal Tuberculosis Leading to Prehepatic Portal Hypertension: A Case Report

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions

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