Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study.
BACKGROUND
Controversy still exists regarding colonic mucosal abnormalities in patients with portal hypertension (portal colopathy). The aims of this study were to better define portal colopathy and to identify risk factors for these colonic mucosal abnormalities.


METHODS
We reviewed the medical records of 437 patients with cirrhosis and portal hypertension and 224 with irritable bowel syndrome (control patients) who underwent colonoscopy over a 6-year period.


RESULTS
Individuals with portal hypertension were significantly more likely than control patients to have colitis-like abnormalities (38% vs. 3%, p < 0.001) and vascular lesions (13% vs. 3%, p < 0.001). In the multivariate model, portal hypertensive gastropathy (odds ratio 5.64: 95% CI [3.39, 9.41]; p < 0.001), 2+ or larger esophageal varices (odds ratio 4.76: 95% CI [2. 78, 8.15]; p < 0.001), and Child-Pugh class C cirrhosis (odds ratio 2.64: 95% CI [1.40, 4.97]; p = 0.003) were independently associated with an increased risk of having portal colopathy, whereas the use of beta-blockers independently decreased the risk of having these findings (odds ratio 0.23: 95% CI [0.13, 0.40]; p < 0.001). Mucosal biopsies of the colon in patients with colitis-like abnormalities revealed a mild, nonspecific inflammatory infiltrate with edema and vascular ectasias in the majority of cases.


CONCLUSIONS
Mucosal abnormalities in portal colopathy include edema, erythema, granularity, friability, and vascular lesions, findings that may be confused with colitis. A standardized grading system to classify the endoscopic appearance and severity of portal colopathy should be adopted.
Bini
E J
EJ
Division of Gastroenterology, VA New York Harbor Healthcare System, Bellevue Hospital, New York University School of Medicine, New York, New York 10010, USA. EdBini@worldnet.att.net
Lascarides
C E
CE
Micale
P L
PL
Weinshel
E H
EH
D000328:Adult; D003106:Colon / Q000473:pathology*; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies