Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study.
BACKGROUND
The frequency of small-bowel mucosal changes in patients with portal hypertension is not known. The objective of the study is to better define the mucosal abnormalities of portal hypertensive enteropathy (PHE) and to determine whether these findings are associated with the severity of liver disease, esophageal varices, portal gastropathy, portal colonopathy, or other clinical characteristics.


METHODS
We compared the medical records of 37 patients with cirrhosis and portal hypertension with 34 control patients who underwent capsule endoscopy over a 3-year period.


RESULTS
Mucosal changes were found to be significantly more common in the cirrhotic patients than in the control patients (67.5% vs. 0, p < 0.001). The lesions included telangiectasias or angiodysplastic-like lesions in 9 (24.3%) patients, red spots in 23 (62.2%), and varices in 3 (8.1%). Active bleeding was seen during endoscopic examinations in 4 (10.8%) patients. A comparison of patients with and those without PHE showed that grade 2+ or larger esophageal varices, portal gastropathy, portal colonopathy, and Child-Pugh class C cirrhosis were all significantly associated with PHE. There were no differences between these two groups of patients with regard to the etiology of cirrhosis, gender, or history of esophageal variceal bleeding.


CONCLUSIONS
Mucosal abnormalities in portal jejunopathy include edema, erythema, and vascular lesions findings. A standardized grading system to classify the endoscopic appearance and the severity of portal enteropathy is proposed. The clinical import of these changes remains to be explained.
De Palma
Giovanni D
GD
Section of Diagnostic and Therapeutic Endoscopy, Department of Surgery and Advanced Technologies, University of Naples Federico II, School of Medicine, Naples, Italy.
Rega
Maria
M
Masone
Stefania
S
Persico
Francesco
F
Siciliano
Saverio
S
Patrone
Francesco
F
Matantuono
Luigi
L
Persico
Giovanni
G
D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007413:Intestinal Mucosa / Q000473:pathology*; D007579:Jejunal Diseases / Q000209:etiology / Q000473:pathology*; D007583:Jejunum / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013686:Telemetry