Colonic findings in cirrhotics with portal hypertension. A prospective colonoscopic and histological study.

Abstract

Total colonoscopy was performed in 38 consecutive cirrhotics (15 alcoholic, 19 postviral, four unknown) with portal hypertension, 32 of whom were enrolled in a program of esophageal sclerotherapy because of variceal bleeding (Child's grading: A, 13; B, 21; C, 4 patients). In 34 of them, multiple biopsies from the colonic mucosa were taken. Fifty non-cirrhotics (roughly matched for age and sex with the patients) who were colonoscoped because of atypical abdominal complaints, served as controls for rectal varices, polyps, and hemorrhoids. Rectal varices occurred in 3 of 38 (7.9%) of cirrhotics with portal hypertension; they were found only in those who had undergone esophageal sclerotherapy, but no association with the number of sclerotherapies was documented; severity and etiology of cirrhosis did not seem to influence their presence. Hemorrhoids and polyps did not seem to occur more frequently in cirrhotics than in controls. Nonspecific inflammatory changes were observed macroscopically in 57.9% of the patients; these were significantly more common in postviral cirrhosis in comparison with alcoholic cirrhosis (p = 0.01967; 95% CI, 0.757-0.155) and, in particular, in the Child's B postviral cirrhosis as compared with the Child's B alcoholic cirrhosis (p = 0.01915; 90% CI, 0.942-0.320). In 15 patients, there was histological evidence of chronic or acute nonspecific inflammation; no associations with the severity or the etiology of the cirrhosis were found. No vascular ectasias or ectasia-like lesions were found.