Portal Hypertensive Colopathy —Endoscopic, Hernodynamic and Morphometric Study—

Abstract

Abstract: Although it is widely accepted that congestive gastropathy is a well recognized manifestation of portal hypertension, the influence of the latter on the lower gastrointestinal tract has not been adequately studied. Therefore, we evaluated prospectively, by total colonoscopy, 30 consecutive cirrhotic patients after their varices were obliterated by endoscopic sclerotherapy. All of them had not had any bleeding episode for some time and all had varying degrees of congestive gastropathy identified by an UGI endoscopy at the time of the study. Additionally, colonic mucosal perfusion was assessed by means of laser‐Doppler flowmetry at 4 defined points on the transverse colon and two mucosal biopsy specimens were obtained from the same area for histology and morphometric analysis of mucosal capillaries. Seven non cirrhotic patients who had undergone colonoscopy for various reasons but had no findings, served as controls. Twenty‐eight patients [rate 93%] were found to have multiple vascular ectasis of differing degrees of severity. These vascular‐looking lesions were mainly located in the right colon and rectosigmoid. Less frequent lesions were non specific mucosal edema, sparse mucosal veins and rectal varices. The statistical evaluation of mucosal perfusion revealed a highly significant decrease of blood flow in the cirrhotic patients [p = 0.00001]. A morphometric analysis revealed a significantly higher mean number of capillaries [p = 0.0012] and a higher mean cross‐sectional vascular area per field in the cirrhotic patients than in the control subjects [p=0.0055]. We concluded that portal hypertension affects the lower gastrointestinal tract giving an endoscopic, microcirculatory and histopathologic pattern quite similar to that of the gastric mucosa.