Spectrum of colonic mucosal abnormalities in patients with cirrhosis and portal hypertension : An Endoscopic study.

INTRODUCTION : Portal hypertension (PHT) is an important complication of chronic liver disease of any etiology. One of the most significant clinical consequences of portal hypertension in cirrhotic patients is the development of gastroesophageal varices, portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). These vascular lesions are considered to be a significant source of upper gastrointestinal bleeding in patients with portal hypertension. Over the past few years, it has been observed that not only the stomach but the entire gastrointestinal tract, with its venous drainage through the portal venous system, is involved in patients with portal hypertension. Involvement of the duodenum , the small intestine , and the colon have all been described. Only a few studies, however, have investigated the colon in patients with portal hypertension. Colorectal mucosal lesions in patients with portal hypertension is termed as portal hypertensive colopathy (PHC). These are thought to be important causes of lower gastrointestinal hemorrhage, although the clinical importance of these lesions in patients with portal hypertension is not well established. The features of PHC are not well defined but include multiple vascular appearing lesions (telangiectasias, cherry red spots and angiodysplasia like lesions), colitis- like abnormalities (granularity, erythema, edema, friability), colorectal varices, or a combination of these findings. The diagnostic criteria and clinical significance of this condition is confusing. This may be partially due to imprecise terminology, lack of uniform endoscopic descriptions, interobserver variability and the absence of distinctive histopathologic features. In this study, we evaluated the prevalence of colonic mucosal changes in patients with chronic liver disease and portal hypertension before and after endoscopic variceal obliteration and its clinical significance. AIM OF THE STUDY : 1. To find out the prevalence of colonic mucosal abnormalities in patients with cirrhosis and portal hypertension. 2. To assess the relationship between colonic mucosal abnormalities and the severity of liver disease. 3. To assess the relationship between colonic mucosal abnormalities and the grading of esophageal varices. 4. To investigate the effect of endoscopic variceal ligation of the esophageal varices on the colonic mucosal changes. CONCLUSION : The prevalence of portal hypertensive colopathy, rectal varix and hemorrhoids in patients with cirrhosis and portal hypertension was 50%, 10% and 20% respectively. The prevalence of portal hypertensive colopathy in patients with cirrhosis and portal hypertension increases with worsening of Child Pugh Turcotte score and increasing grading of esophageal varices. Esophageal variceal obliteration by endoscopic variceal ligation did not influence the occurrence of any of the colonic mucosal abnormalities in patients with cirrhosis and portal hypertension