Background and Study Aims: Figures for the prevalence of anorectal varices and portal hypertensive colopathy have varied considerably in the available studies of patients with cirrhosis, and few studies have observed these changes in patients with extrahepatic portal vein obstruction (EHPVO). Our aim was to investigate the colonic changes, if any, in patients with EHPVO and to compare them with those seen in patients with cirrhosis of the liver. Patients and Methods: A total of 50 patients with cirrhosis and 35 patients with EHPVO, all of whom had a history of at least one episode of bleeding from esophageal varices, underwent both upper gastrointestinal endoscopy and colonoscopy. Results: Anorectal varices were seen more commonly in patients with EHPVO than in patients with cirrhosis (63 % vs. 38 %, P < 0.03). Of the patients with anorectal varices, large anorectal varices were also more common in patients with EHPVO than in patients with cirrhosis (73 % vs. 32 %, P < 0.01). Colopathy was noted in 40 % of patients with EHPVO and in 62 % of patients with cirrhosis (P < 0.05). Of the patients with EHPVO, colopathy was noted in 27 % of patients who also had anorectal varices and in 61.5 % of patients without anorectal varices (P < 0.05). Similarly, patients with both cirrhosis and anorectal varices were found to have a lower prevalence of colopathy than cirrhotic patients without anorectal varices (42 % vs. 74 %, P < 0.03). Conclusions: Anorectal varices are more common in patients with EHPVO, while portal hypertensive colopathy is more common in patients with cirrhosis. Large anorectal varices are also more common in patients with EHPVO than in patients with cirrhosis and there is an inverse relationship between anorectal varices and colopathy in both cirrhotic patients and patients with EHPVO.
References
1
McCormack T T, Sims J, Eyre-Brook I. et al .
Lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?.
Gut.
1985;
26
1226-1232
5
Misra S P, Dwivedi M, Misra V. et al .
Endoscopic and histological appearance of the gastric mucosa in patients with portal hypertension.
Gastrointest Endosc.
1990;
36
575-579
9
Sarin S K, Sreenivas D V, Lahoti D. et al .
Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension.
Gastroenterology.
1992;
102
994-999
10
Viggiano T R, Gostout C J.
Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic and histopathological features.
Am J Gastroenterol.
1992;
87
944-954
11
Gupta R, Saraswat V A, Kumar M. et al .
Frequency and factors influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension.
J Gastroenterol Hepatol.
1996;
11
728-733
12
Thiruvengadam R, Gostout C J.
Congestive gastroenteropathy: an extension of nonvariceal upper gastrointestinal bleeding in portal hypertension.
Gastrointest Endosc.
1989;
35
504-507
16
Kozarek R A, Botoman V A, Bredfeldt J E. et al .
Portal colopathy: prospective study in patients with portal hypertension.
Gastroenterology.
1991;
101
1192-1197
18
Ganguly S, Sarin S K, Bahtia V. et al .
The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension.
Hepatology.
1995;
21
1226-1231
19
Misra S P, Dwivedi M, Misra V.
Prevalence and factors influencing hemorrhoids, anorectal varices and colopathy in patients with portal hypertension.
Endoscopy.
1996;
29
340-345
20
Misra S P, Misra V, Dwivedi M.
Effect of esophageal variceal sclerotherapy on hemorrhoids, anorectal varices and portal colopathy.
Endoscopy.
1999;
31
741-744
21
Misra S P, Misra V, Dwivedi M.
Effect of esophageal variceal ligation on hemorrhoids, anorectal varices and portal colopathy.
Endoscopy.
2002;
34
195-198
23
Bini E J, Lascarides C E, Micale P L. et al .
Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study.
Gastrointest Endosc.
1999;
52
511-516
24
Weinshel E, Chen W, Falkenstein D B. et al .
Hemorrhoids or rectal varices: defining the cause of massive rectal hemorrhage in patients with portal hypertension.
Gastroenterology.
1986;
90
744-747
26
Katz J A, Rubin R A, Cope C. et al .
Recurrent bleeding from anorectal varices: successful treatment with a transjugular intrahepatic portosystemic shunt.
Am J Gastroenterol.
1993;
88
1104-1107
28
Goenka M K, Kochhar R, Negi B. et al .
Rectosigmoid varices and other mucosal changes in patients with portal hypertension.
Am J Gastroenterol.
1991;
86
1185-1189
29
Misra S P, Sarin S K, Gulati P. et al .
Splenoportovenography: safety, success rate and hemodynamic changes, and incidence and natural history of splenic hematoma.
Indian J Gastroenterol.
1991;
10
49-50
30
Conn H O.
Ammonia tolerance in the diagnosis of esophageal varices: a comparison of endoscopic, radiologic, and biochemical techniques.
J Lab Clin Med.
1967;
70
442-449
32
Britton R C.
Influence of portal-systemic collateral patterns and distribution of varices on results of surgical treatment of bleeding esophageal varices.
Surgery.
1963;
53
567-574
34
Iwao T, Toyonaga A, Oho K. et al .
Portal hypertensive gastropathy develops less in patients with cirrhosis and fundal varices.
J Hepatol.
1997;
26
1235-1241
35
Tayama C, Iwao T, Oho K. et al .
Effect of large fundal varices in gastric mucosal hemodynamics after endoscopic variceal ligation.
Endoscopy.
1998;
30
25-31
39
Rabinovitz M, Schade P R, Dindzans V J. et al .
Colonic disease in cirrhosis: an endoscopic evaluation in 412 patients.
Gastroenterology.
1990;
99
195-199
41
Scandalis N, Archimandritis A, Kastanas K. et al .
Colonic findings in cirrhotics with portal hypertension: a prospective colonoscopic and histological study.
J Clin Gastroenterol.
1994;
18
325-329
42
Bresci G, Gambardella L, Parasi G. et al .
Colonic disease in cirrhotic patients with portal hypertension: an endoscopic and clinical evaluation.
J Clin Gastroenterol.
1998;
26
222-227
