Evaluation of rectal mucosal hemodynamics in patients with liver cirrhosis using reflectance spectrophotometry.
OBJECTIVE
Portal hypertensive colonopathy is observed in patients with liver cirrhosis. To determine the correlation between rectal mucosal hemodynamics and portal hypertensive colonopathy, we observed rectal mucosal findings and measured rectal mucosal hemodynamics in patients with liver cirrhosis.


METHODS
Thirty-four patients with liver cirrhosis and 16 healthy control subjects were simultaneously examined for rectal mucosal findings by colonoscopy and indices of rectal mucosal Hb concentration (RHb) and rectal mucosal oxygen saturation by reflectance spectrophotometry. Endoscopic findings in the rectal mucosa of patients with liver cirrhosis included vascular ectasias, blue veins, and varices. We investigated the relationship between rectal mucosal hemodynamics and clinical parameters of liver cirrhosis (Child-Pugh classification, the amount of indocyanine green remaining in the blood 15 min after its injection, and ascites). Patients with hepatocellular carcinoma, colonic cancer, multiple colonic polyps, or severe anemia were excluded.


RESULTS
Rectal mucosal lesions were observed in 11 patients with liver cirrhosis (32.4%). In the hemodynamic studies, we found significantly increased RHb values in the cirrhosis group as compared with the control group. On the other hand, there was no significant change in rectal mucosal oxygen saturation between the two groups. A significant increase in RHb was observed in patients with rectal mucosal lesions in the cirrhosis group. RHb in the cirrhosis group correlated with grade of Child-Pugh classification. Increased RHb decreased in parallel after portal decompression by creation of a transjugular intravenous portosystemic stent shunt.


CONCLUSIONS
The rectal mucosal lesions in liver cirrhosis correlate with an increase in RHb, which correlates with portal hypertension.
Tezuka
T
T
Second Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Akita
Y
Y
Yoshikawa
N
N
Mitamura
K
K
D001201:Ascites; D003113:Colonoscopy; D004396:Coloring Agents; D005069:Evaluation Studies as Topic; D005260:Female; D006439:Hemodynamics; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology; D007208:Indocyanine Green; D007413:Intestinal Mucosa / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012002:Rectal Diseases / Q000209:etiology / Q000503:physiopathology; D012007:Rectum / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D013053:Spectrophotometry / Q000379:methods; D013684:Telangiectasis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D014648:Varicose Veins / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D014680:Veins / Q000473:pathology
D004396:Coloring Agents; D006454:Hemoglobins; D007208:Indocyanine Green