Colonic mucosal changes in Egyptian patients with liver cirrhosis and portal hypertension

Abstract

Background and aims In patients with liver cirrhosis and portal hypertension (PHT), portal hypertensive colopathy (PHC) is thought to be an important cause of lower gastrointestinal bleeding. This study aimed at evaluating the prevalence and clinical significance of colonic mucosal changes in Egyptian patients with liver cirrhosis and PHT. Patients and methods A prospective study was conducted on 35 patients with liver cirrhosis and PHT (proved by upper endoscopy and/or abdominal ultrasonography). They were evaluated using full colonoscopy to detect changes in colonic mucosa and using gastroscopy to detect the presence of both gastroesophageal varices and portal hypertensive gastropathy. Results Colonic lesions were found in 27 patients (77.1%), including haemorrhoids in 20 patients (57.1%), diffuse hyperaemic mucosa in 16 patients (45.7%), angiodysplastic lesions in 12 patients (34.3%) and rectal varices in five patients (14.3%). Bleeding per rectum was detected in seven patients (20%), and it significantly correlated with the presence of haemorrhoids ( P = 0.02). The prevalence of PHC and the presence of haemorrhoids increased with the worsening Child-Pugh class ( P = 0.01 and 0.02, respectively). Conclusion The prevalence of PHC and haemorrhoids increases with the progression of liver disease and worsening of the Child-Pugh grading in cirrhotic patients. However, haemorrhoids, rectal varices, hyperaemia and colonic angiodysplasia are not affected by the presence of portal hypertensive gastropathy.