Predictive Factors of Portal Hypertensive Enteropathy Exacerbation in Patients with Liver Cirrhosis: A Capsule Endoscopy Study

Abstract

Background/Aims: The clinical course and exacerbation of portal hypertensive enteropathy (PHE) are yet to be fully clarified. This study aimed to identify factors related to PHE exacerbation in patients with liver cirrhosis (LC). Methods: Fifty patients with LC (33 male; mean age, 67 years), who underwent capsule endoscopy (CE) at the Hiroshima University Hospital between February 2009 and September 2015, were followed up for >6 months. Exacerbation is defined as the appearance of new lesions or worsening of existing lesions. The association between PHE exacerbation and the clinical factors was evaluated. Results: PHE exacerbation was identified in 24 out of 50 (48%) of cases: erythema (14 cases); angioectasia (11 cases); erosions (9 cases); villous edema (8 cases); and esophageal varices (EVs; 6 cases). The following factors were significantly associated with PHE exacerbation: portosystemic shunts, EVs and portal hypertensive gastropathy (PHG) exacerbation. After therapy, CE findings among the 24 cases were as follows: villous edema (19 cases); erythema (17 cases); angioectasia (16 cases); erosions (12 cases); and EVs (9 cases), and no observable abnormalities in 2 cases. On multivariate analysis, exacerbation of EVs and PHG were independent predictors of PHE exacerbation. Conclusion: EVs and PHG exacerbation may predict PHE exacerbation in patients with LC.

Management of occult obscure gastrointestinal bleeding patients based on long-term outcomes

“…In addition, LC, hematologic disease, and the lowest hemoglobin levels were identified in patients with occult OGIB. 13 , 14 …”

“…In addition, LC, hematologic disease, and the lowest hemoglobin levels were identified in patients with occult OGIB. 13,14 Regarding rebleeding after treatment, we previously reported that a good outcome could be expected for patients who undergo total enteroscopy and receive proper treatment for the source of bleeding in the small bowel. 15 Aoki and colleagues 16 reported that the rebleeding rate was lower for single ulcerations than for multiple ulcerations in OGIB patients with ulcerative lesions.…”

Exacerbation of Portal Hypertensive Enteropathy after Endoscopic Injection Sclerotherapy for Esophageal Varices

“…Diagnoses were made by consensus. In accordance with a previous report, PHE was defined as the presence of erythema, erosion, angioectasia, varices, and/or villous edema; exacerbation was defined as the appearance of new lesions or worsening of existing lesions in the small-bowel (degree or range) [9]. Villous edema exacerbation is defined as progression of the lesion range and development of severe villous edema, so that identification of the lumen of the smallbowel is no longer possible [11].…”

“…De Palma et al [4] defined these changes as portal hypertensive enteropathy (PHE), which presents as inflammatorylike lesions (edematous, erythematous, granular, and friable lesions) and/or vascular lesions (cherry red spots, telangiectasias, angiodysplasia-like lesions, and varices). In particular, vascular lesions associated with PHE cause small-bowel bleeding, which is a clinically noteworthy finding [8,9]. Previously, we reported capsule endoscopy (CE) as a useful diagnostic modality for detecting PHE in patients with compensated LC [10].…”

“…Previously, we reported capsule endoscopy (CE) as a useful diagnostic modality for detecting PHE in patients with compensated LC [10]. Some reports have described predictors of the appearance and/or exacerbation of PHE [9][10][11]. We also reported that aggravation of esophageal varices (EV) and portal hypertensive gastropathy can predict exacerbation of PHE in LC patients [9], and that the clinical factors related to portal hypertension (portal hypertensive gastropathy, Child-Pugh class B or C, and portal vein thrombus) were significantly correlated with the presence of and worsening of villous edema [11].…”