Abstract
Background The features of the portal hypertension enteropathy (PHE) vary from mild mucosal changes to varices with or without bleeding. The prevalence and the development are not fully understood. Aim Our aim is to examine the prevalence and the different manifestations of PHE using video capsule endoscopy (VCE). Methods It is a single center retrospective study of patients with cirrhosis, who had VCE. Based on the published literature, we divided the PHE lesions into vascular lesions and mucosal lesions. Results Of the 100 patients with cirrhosis that had a VCE study, the mean age was 62.82 years. Male gender was predominant (64%), while Caucasians represented 82% of the cohort. The most common etiology of cirrhosis was chronic alcohol abuse followed by chronic hepatitis C virus and nonalcoholic steatohepatitis. VCE detected small bowel lesions in 71% of the patients while the features of PHE were found in 65% from the total cohort. AVMs and inflammatory changes were the most common findings, followed by bleeding. More than 50% of the lesions were vascular in nature. The risk of finding PHE in decompensated cirrhosis is twice that in compensated cirrhosis. Forty-five patients had negative EGD exam for any active bleeding, esophageal varices, portal hypertensive gastropathy, or gastric varices. Of these, 69% had features of PHE in their VCE. Conclusions VCE detected small bowel lesions in 71% of our cohort. There is a high prevalence of PHE in decompensated cirrhosis. Vascular lesions are the most common finding in the small bowel of this population.
Highlights
Cirrhosis or end-stage liver disease is defined as a late stage of scarring and fibrosis of the liver and characterized by alteration of the hepatic architecture as well as the development of regenerative nodules; these changes can lead to a multitude of complications
The most common etiologies of the cirrhosis in our cohort were chronic alcohol abuse followed by chronic hepatitis C virus (HCV) and nonalcoholic steatohepatitis (NASH) with percentages of 37%, 22%, and 18%, respectively (Figure 1)
Vascular lesions were found in 43% of the cohort and inflammatory lesions were found in 33%. 11 patients were found to have more than one type of portal hypertension enteropathy (PHE) types with vascular lesions comprising more than 50% of the PHE lesions
Summary
Cirrhosis or end-stage liver disease is defined as a late stage of scarring and fibrosis of the liver and characterized by alteration of the hepatic architecture as well as the development of regenerative nodules; these changes can lead to a multitude of complications. Reports from the Centers for Disease Control (CDC) estimate that 75,766 deaths and 2.3 million years of potential life lost during 2001 were attributable to excessive alcohol abuse, which contributed to 60-70% of the cirrhosis in the USA. It is the 12th leading cause of death in USA and it is the leading cause of morbidity [2]. VCE detected small bowel lesions in 71% of the patients while the features of PHE were found in 65% from the total cohort. Vascular lesions are the most common finding in the small bowel of this population
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