Endoscopy 2006; 38(8): 830-835
DOI: 10.1055/s-2006-944629
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical relevance of colonic lesions in cirrhotic patients with portal hypertension

G.  Bresci1 , G.  Parisi1 , A.  Capria1
  • 1 Dept. of Gastroenterological Surgery, Pisa Hospital Administration, Pisa, Italy
Further Information

Publication History

Submitted 23 December 2005

Accepted after revision 24 March 2006

Publication Date:
28 August 2006 (online)

Background and study aims: This prospective study was conducted in order to evaluate whether the colonic lesions previously described in cirrhotic patients may be of clinical relevance.
Patients and methods: Eighty-five patients with cirrhosis of the liver, but without colonic or systemic diseases unrelated to the liver disease, underwent colonoscopy and were followed up for at least 2 years.
Results: Colonic varices were observed in 31 % of the patients, portal hypertensive colopathy (PHC; defined as diffuse hyperemia, edema, spider angiomas, and spontaneous bleeding of the colonic mucosa) in 54 %, and normal colonic findings in 18 %. Colonic varices and PHC were present simultaneously in 27 % of the patients. Previous sclerotherapy or band ligation treatment for esophageal varices had been carried out in 27 % and 23 % of the patients, respectively. Portal hypertensive gastropathy was observed in 42 % of the patients. Polyps were found in 12 % of the cirrhotic patients and cancer in 3 %. All of the patients were followed up for at least 2 years; 34 % of them developed upper gastrointestinal hemorrhage (81 % from esophageal varices, 19 % from the stomach), while only 6 % developed lower gastrointestinal bleeding.
Conclusions: Colonic lesions are frequent in cirrhotic patients, but statistical analysis showed that these lesions are not specific for the disease and do not correlate with the etiology and degree of cirrhosis, with the endoscopic treatment of esophageal varices, or with the risk of bleeding from the lower gastrointestinal tract.

References

  • 1 McCormack T T, Sims J, Eyre-Brook I. et al . Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?.  Gut. 1985;  26 1226-1232
  • 2 Papazian A, Braillon A, Dupas J L. et al . Portal hypertensive gastric mucosa: an endoscopic study.  Gut. 1986;  27 1199-1203
  • 3 Viggiano T R, Gostout C J. Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic and histologic features.  Am J Gastroenterol. 1992;  87 944-954
  • 4 Rabinovitz M, Schade R, Dindzans V J. et al . Colonic disease in cirrhosis.  Gastroenterology. 1990;  99 195-199
  • 5 Hamlyn A N, Lunzer M R, Morris J S. et al . Portal hypertension with varices in unusual sites.  Lancet. 1974;  ii 1531-1534
  • 6 Naveau S, Bedossa P, Poynard T. et al . Portal hypertensive colopathy: a new entity.  Dig Dis Sci. 1991;  36 1774-1781
  • 7 Ganguly S, Sarin S K, Bahtia V, Lahoti D. The prevalence and spectrum of colonic lesions in patients with cirrhotic and non-cirrhotic portal hypertension.  Hepatology. 1995;  21 1226-1231
  • 8 Lebrec D, Benhamou J P, Onstad G R. Ectopic varices in portal hypertension.  Clin Gastroenterol. 1985;  14 105-121
  • 9 Feldman M, Smith V M, Warner C G. Varices of the colon: report of three cases.  JAMA. 1962;  179 729-730
  • 10 Kozarek R A, Botoman V A, Bredfeldt J E. et al . Portal colopathy: prospective study of colonoscopy in patients with portal hypertension.  Gastroenterology. 1991;  101 1192-1197
  • 11 Hosking S W, Smart H L, Johnson A G, Triger D R. Anorectal varices, haemorrhoids, and portal hypertension.  Lancet. 1989;  i 349-352
  • 12 Rabinovitz M, Yoo Y K, Schade R R. et al . Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively.  Dig Dis Sci. 1990;  35 705-750
  • 13 Misra S P, Dwivedi M, Misra V. Prevalence and factors influencing hemorrhoids, anorectal varices and colopathy in patients with portal hypertension.  Endoscopy. 1996;  29 340-345
  • 14 Japanese Research Society for Portal Hypertension . The general rules for recording endoscopic findings on esophageal varices.  Jpn J Surg. 1980;  10 84-87
  • 15 Sarin S K, Sreenivas D V, Lahoti D, Saraya A. Factors influencing the development of portal hypertensive gastropathy in patients with portal hypertension.  Gastroenterology. 1992;  102 994-999
  • 16 Vigneri S, Termini R, Piraino A. et al . The stomach in liver cirrhosis: endoscopic, morphological, and clinical correlations.  Gastroenterology. 1991;  101 472-478
  • 17 Gupta R, Saraswat V A, Kumar M. et al . Frequency and factors influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension.  J Gastroenterol Hepatol. 1996;  11 728-733
  • 18 D’Amico G, Montalbano L, Traina M. et al . Natural history of congestive gastropathy in cirrhosis.  Gastroenterology. 1990;  99 1558-1564
  • 19 Jacobs D M, Bubrick M P, Onstad G R. The relationship of hemorrhoids to portal hypertension.  Dis Colon Rectum. 1980;  23 567-569
  • 20 Chawla Y, Dilawari J B. Anorectal varices: their frequency in cirrhotic and non-cirrhotic portal hypertension.  Gut. 1991;  32 309-311
  • 21 Scandalis A, Archimandritis A, Kastanas K. et al . Colonic findings in cirrhotics with portal hypertension.  J Clin Gastroenterol. 1994;  18 325-329
  • 22 Tam T N, Ng W W, Lee S D. Colonic mucosal changes in patients with liver cirrhosis.  Gastrointest Endosc. 1995;  42 408-412
  • 23 Bresci G, Gambardella L, Parisi G. et al . Colonoscopic disease in cirrhotic patients with portal hypertension: an endoscopic and clinical evaluation.  J Clin Gastroenterol. 1998;  26 222-227
  • 24 Misra S P, Misra V, Dwivedi M. Effect of esophageal variceal sclerotherapy on hemorrhoids, anorectal varices and portal colopathy.  Endoscopy. 1999;  31 741-744
  • 25 Bini J, Lascarides C E, Micale P L, Weinshel E H. Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study.  Gastrointest Endosc. 2000;  4 511-516
  • 26 Chaput J C, Naveau S, Buffet C, Vitaux J M. Relation entre la cirrhose alcoolique et les cancers extra-hépatiques non liés à l’alcool ou au tabac.  Gastroenterol Clin Biol. 1984;  8 883-887
  • 27 Iwao T, Toyonaga A, Oho K. et al . Portal hypertensive gastropathy develops less in patients with cirrhosis and fundal varices.  J Hepatol. 1997;  26 1235-1241
  • 28 Naveau S, Chaput J C, Bedossa P. et al . Cirrhosis as an independent risk factor for colonic adenomas.  Gut. 1992;  33 535-540
  • 29 Eleftheriadis E, Kotazampassi K, Karakavelas . Portal hypertensive colopathy: endoscopic, haemodynamic and morphometric study.  Dig Endosc. 1993;  5 224-230

G. Bresci, M. D.

U. O. Gastroenterology

Via A. della Spina, 11 · 56125 Pisa · Italy

Fax: +39-050-45227·

Email: gbresci@libero.it

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