Small intestinal edema had the strongest correlation with portal venous pressure amongst capsule endoscopy findings.
OBJECTIVE
Previous studies have reported small intestinal lesions in patients with portal hypertensive disease. However, the etiology of these lesions is not clear, as portal venous pressure was not measured in any of these studies. The aim of this study is to clarify the association between small intestinal lesions and hepatic venous pressure gradient (HVPG), which correlates well with portal venous pressure.


METHODS
Thirty-five patients with liver cirrhosis were evaluated by capsule endoscopy for small intestinal lesions. HVPG was measured within 3 days of capsule endoscopy. Blood tests, clinical symptoms, Child-Pugh classification and HVPG were analyzed against small intestinal lesions such as edemas, red spots, angiodysplasia and varices. Lesions were categorized according to their location in the duodenum, jejunum or ileum. Edema was evaluated using a 4-grade capsule endoscopy scoring index.


RESULTS
HVPG and edema scores increased with Child-Pugh scores. Red spots and angiodysplasia did not correlate with HVPG. Varices were detected in only 5 patients. The edema score was the factor which most strongly correlated with HVPG by multivariate analysis (p = 0.0008). There was also a strong linear relation between edema scores and HVPG (R = 0.75, p < 0.0001).


CONCLUSIONS
Small intestinal edemas showed the strongest correlation with HVPG among all small intestinal lesions.
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Yoko
Y
Takahashi
Shunji
S
Fujimori
Yoshiyuki
Y
Narahara
Katya
K
Gudis
Yukiko
Y
Ensaka
Yuki
Y
Kosugi
Kotaro
K
Maki
Masahiro
M
Suzuki
Yoko
Y
Matsushita
Takeshi
T
Fukuda
Hidenori
H
Kanazawa
Choitsu
C
Sakamoto
D000368:Aged; D053704:Capsule Endoscopy; D004378:Duodenal Diseases / Q000209:etiology / Q000473:pathology; D004487:Edema / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology*; D007077:Ileal Diseases / Q000209:etiology / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology* / Q000503:physiopathology; D007579:Jejunal Diseases / Q000209:etiology / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017082:Portal Pressure