THE PREVALENCE AND SPECTRUM OF COLONIC LESIONS IN PATIENTS WITH CIRRHOTIC AND NONCIRRHOTIC PORTAL-HYPERTENSION

Portal hypertension diffusely affects the gastrointestinal tract. The frequency and profile of distinct colonic mucosal lesions (portal colo pathy) and rectal varices (RV; veins >4 cm above the anal verge) is no t well studied. Fifty consecutive patients with portal hypertension (2 5 with cirrhosis, 10 with noncirrhotic portal fibrosis [NCPF], and 15 with extrahepatic portal vein obstruction [EHPVO]) were assessed clini cally and by upper and lower gastrointestinal (GI) endoscopy. Colorect al lesions were seen in 35 (70%) patients, significantly more often in bleeders than in nonbleeders. Rectal varices were detected in 22 (44% ) patients; larger and more often seen in EHPVO (80%) than in cirrhosi s (28%) and NCPF (308) (P < .01) patients. Portal colopathy was seen i n 26 (52%) patients, with nearly similar frequency in cirrhotics, NCPF , and EHPVO patients. Previous sclerotherapy or presence of gastric va rices had little influence on the development of these lesions. An ass ociation (P < .01) was, however, seen between the presence of colopath y and portal gastropathy. Overt bleeding was seen in 8% and 4% of pati ents with RV and colopathy, respectively. In conclusion, our results d emonstrate that colorectal lesions are present in about two thirds of patients with portal hypertension. Patients with portal hypertension a nd lower GI bleeding should be colonoscoped. Patients with extrahepati c portal vein obstruction may in turn benefit from baseline sigmoidosc opic examination to define the presence and size of rectal varices.