VASCULAR ALTERATIONS OF THE COLONIC MUCOSA IN SCHISTOSOMIASIS AND PORTAL COLOPATHY

Background/Aims: Portal colopathy, the occurrence of vascular-ectasia like lesions has been observed in patients with portal hypertension of variable etiology. Schistosomiasis is a major cause of liver damage a nd portal hypertension. In colonic schistosomiasis, vascular alteratio ns are commonly observed. It is therefore possible that schistosomiasi s may induce portal colopathy in addition to inflammatory changes dire ctly induced by oviposition. Materials and Methods: In order to examin e this possibility, we reviewed the endoscopic data obtained in 100 co nsecutive patients with established bilharziosis. In addition, endosco pic biopsies from all patients were examined for the presence of infla mmation, parasite eggs, granulomas and mucosal vascular congestion. Th e latter was assessed using immunohistochemical staining for Ulex Euro paeus. Results: Endoscopic abnormalities were observed in 66/100 patie nts. The main lesions were abnormalities in vascularisation of the muc osa, especially hyperemia, defined as the presence of numerous, promin ent and irregular vessels (62%) and telangiectasia (4%). The mucosal b iopsies revealed prominent vascularisation in 60% of the cases. Positi vity for ulex staining was significantly correlated with the finding o f hyperemia during endoscopy and with the presence of ova. No good cor relation was found with the clinical presentation. The lesions were no t well correlated with the presence of an increased cellular infiltrat e in mucosal biopsies. Conclusions: This observation suggests that por tal colopathy may explain some of the endoscopic lesions observed in t he colon of patients with Schistosomiasis.