title: Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients?
abstract: OBJECTIVE
  Recently, mucosal changes of small bowel were defined by developing new imaging techniques including capsule endoscopy (CE) in portal hypertensive patients. However, the clinical impact of these changes is unknown. In this study, we aimed to determine the additional cause of blood loss in portal hypertensive patients.
  
  
  METHODS
  A total of 444 portal hypertensive patients, hospitalized in our clinic between 2005 and 2007, were evaluated. Patients with obscure bleeding were enrolled to this prospective case-control study. CE was performed in 21 patients who met inclusion criteria. Gastroscopy, colonoscopy and computerized tomography/small bowel enema were performed in all patients.
  
  
  RESULTS
  Fourteen cirrhotic and seven noncirrhotic portal hypertensive patients were enrolled to this study. Mean age of patients was 47.9±15.6 years, and 13 of 21 were male. Small bowel varices were found in 7 patients (1 active bleeding) and other mucosal abnormalities in 10 patients (vascular ectasia, erosion and edema, 1 active bleeding). Although two of them were normal, jejunal malignant mass was found in two patients (1 active bleeding). Of 21 patients, 19 (90.5%) patients had portal hypertensive abnormalities (including varices). However, ileal varices rate was 57.1% (4 patients) in noncirrhotic portal hypertensive patients and 21.4% (3 patients) in cirrhotics.
  
  
  CONCLUSIONS
  Ninety percent of patients had portal hypertensive abnormalities in small bowel and one-third of them had small bowel varices. Small bowel varices and vascular ectasia were the main causes of obscure bleeding in portal hypertensive patients.
authors.affiliation: Istanbul Medical Faculty, Department of Gastroenterology, Capa-Istanbul, Turkey. filizakyuz@hotmail.com
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyuz
authors.forename: Binnur
authors.initials: B
authors.lastname: Pinarbasi
authors.forename: Fatih
authors.initials: F
authors.lastname: Ermis
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uyanikoglu
authors.forename: Kadir
authors.initials: K
authors.lastname: Demir
authors.forename: Sadakat
authors.initials: S
authors.lastname: Ozdil
authors.forename: Fatih
authors.initials: F
authors.lastname: Besisik
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Kaymakoglu
authors.forename: Gungor
authors.initials: G
authors.lastname: Boztas
authors.forename: Zeynel
authors.initials: Z
authors.lastname: Mungan
mesh_terms: D000328:Adult; D053704:Capsule Endoscopy; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged