Endoscopic Findings and Clinical Significance of Portal Hypertensive Colopathy

In Beom Jeong; Tae Hee Lee; Seong Min Lim; Ki Hyun Ryu; Yong Seok Kim; Sun Moon Kim; Euyi Hyeog Im; Kyu Chan Huh; Young Woo Choi; Young Woo Kang

doi:10.4166/kjg.2011.58.6.332

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Jeong, Lee, Lim, Ryu, Kim, Kim, Im, Huh, Choi, and Kang: Endoscopic Findings and Clinical Significance of Portal Hypertensive Colopathy

Original Article

Korean J Gastroenterol 2011;58(6):332-337.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.6.332

Endoscopic Findings and Clinical Significance of Portal Hypertensive Colopathy

In Beom Jeong, Tae Hee Lee, Seong Min Lim, Ki Hyun Ryu, Yong Seok Kim, Sun Moon Kim, Euyi Hyeog Im, Kyu Chan Huh, Young Woo Choi, Young Woo Kang

Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

Correspondence to: Tae Hee Lee, Department of Internal Medicine, Konyang University College of Medicine, 685, Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea. Tel: +82-42-600-9370, Fax: +82-42-600-9090, E-mail: green740@naver.com

Received 30 May 2011 Accepted 4 August 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The endoscopic findings and clinical relevance of portal hypertensive colopathy are not well described in Korea. We aimed to do a retrospective study of mucosal changes in the colon of patients with liver cirrhosis and to find their association with clinical characteristics.

Methods

We reviewed the clinical data and endoscopic findings of 48 patients with liver cirrhosis and 48 patients, matched for age and sex, with irritable bowel disease (IBS) who underwent colonoscopy over a 5 year span.

Results

Patients with liver cirrhosis were more likely to have colitis-like lesions and vascular abnormalities than IBS patients. Low platelet count (p=0.005) and severe esophageal varices (p=0.011) were associated with portal hypertensive colopathy, whereas the etiologies and severity of cirrhosis were not associated with these findings.

Conclusions

Portal hypertensive colopathy can be defined with colitis-like lesions or vascular lesions. These lesions are more frequently present in patients with more severe esophageal varices and thrombocytopenia.

Keywords: Liver cirrhosis, Portal hypertension, Colopathy

References

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Fig. 1.

Endoscopic images illustrating portal hypertensive colopathy. (A) Colitis-like diffuse erythema with edema. (B) Mixed form of angiodysplasia-like lesion with multiple small patchy erythema. (C) Angiodysplasia-like vascular lesion.

Table 1.

Characteristics of the Enrolled Patients

	Liver cirrhosis (n=48)	Controls (n=48)	p-value
Age	57.3±10.2	57.3±10.2	1.000
Male/female (n)	32/16	32/16	1.000
Current alcohol	28 (58.3)	18 (37.5)	0.041
drinking
Smoker	16 (33.3)	17 (35.4)	0.830
Diabetes	14 (29.1)	8 (16.7)	0.145
Hypertension	7 (14.6)	15 (31.2)	0.052

Values are presented as mean±SD or n (%).

Table 2.

Clinical Characteristics of 48 Patients with Liver Cirrhosis

Clinical characteristics	n (%)
Etiology
Alcoholic	23 (47.9)
HBV	17 (35.4)
HCV	5 (10.4)
Cryptogenic	1 (2.1)
Alcoholic＋ HBV	1 (2.1)
HBV＋ HCV	1 (2.1)
Child-Pugh class
A	29 (60.4)
B	12 (25.0)
C	7 (14.6)
Other characteristics
Gastroesophageal varices	34 (70.8)
EV F1	10 (20.8)
EV F2, F3	22 (45.8)
Gastric varices	2 (4.2)
Prior EV treatment	16 (33.6)
β-blocker therapy	17 (35.4)

HBV, hepatitis B virus; HCV, hepatitis C virus; EV, esophageal varices.

Table 3.

Colonic Abnormalities in Cirrhotic Patients and Control Patients

Colonic abnormalities	Liver cirrhosis (n=48)	s Controls (n=48)	p-value
Portal hypertensive colopathy	22 (45.8)	2 (4.2)	＜0.001
Colitis-like lesions	8 (16.6)	0 (0.0)	0.006
Vascular abnormalities	20 (41.7)	2 (4.2)	＜0.001
Rectal varices	12 (25.0)	0 (0.0)	＜0.001
Hemorrhoids	12 (25.0)	5 (10.4)	0.061

Values are presented as n (%).

Table 4.

Comparison of Cirrhotic Patients with and without Portal Hypertensive Colopathy

	Portal hypertensive colopathy	(n=22) No colopathy (n=26)	p-value
Age	60.4±8.3	54.8±11.1	0.057
Sex (male/female)	15/7 (68.2/31.8)	17/9 (65.4/34.6)	0.838
Etiology
Alcoholic	9 (40.9)	15 (57.7)	0.247
HBV	10 (45.5)	9 (34.6)	0.444
Platelet count (×10³/μ L)	91.2±48.2	137.1±75.0	0.005
EV (F2, F3)	14 (63.6)	7 (26.9)	0.011
Portal hypertensive gastropathy	17 (77.3)	13 (50.0)	0.052
β-blocker therapy	10 (45.5)	7 (26.9)	0.181
Prior EV therapy	10 (45.5)	6 (23.1)	0.101
Child-Pugh class A/B＋ C	14/8 (63.6/36.4)	15/11 (57.7/42.3)	0.675
MELD score	11.1±4.7	8.9±4.6	0.054

HBV, hepatitis B virus; EV, esophageal varices; LC, liver cirrhosis; MELD, model for end-stage liver disease.

Values are presented as mean±SD or n (%).

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