COLONIC DISEASE IN CIRRHOTIC-PATIENTS WITH PORTAL-HYPERTENSION - AN ENDOSCOPIC AND CLINICAL-EVALUATION

Fifty cirrhotic patients with portal hypertension but without colonic or systemic disease underwent lower gastrointestinal endoscopy in orde r to investigate the effects, if any, of portal hypertension on the co lon. Fifty patients without liver or systemic disease, examined by col onoscopy because of irritable bowel syndrome in the same period served as controls. Rectosigmoid varices were observed in 34% of the cirrhot ic patients and 2% of the controls. Hemorrhoids were observed in 70% o f the cirrhotic patients and 48% of the controls. Multiple vascular-ap pearing lesions were found in 16% of the cirrhotic patients and 6% of the controls. Nonspecific inflammatory changes were noted in 10% of th e cirrhotic patients and 4% of the controls. Simultaneous presence, in the same patient, of rectosigmoid varices, hemorrhoids, multiple vasc ular-appearing lesions, and nonspecific inflammatory changes, was obse rved in only five (10%) of the cirrhotic patients. We found polyps in 12% of the cirrhotic patients and 14% of the controls, and a malignant tumor in 4% of the cirrhotic patients. The patients with normal colon oscopic findings were 8% of the cirrhotic patients and 36% of the cont rols. All patients and controls were followed up for 1 year; there was no gastrointestinal hemorrhage among controls, whereas 34% of the cir rhotic patients had an upper gastrointestinal hemorrhage (88% from eso phageal varices, 12% from the stomach) and 4% had a lower gastrointest inal hemorrhage (one from rectosigmoid varices and one from nonspecifi c inflammatory lesions). Colonic lesions were significantly more frequ ent in the cirrhotic patients (92%) than in the control group (64%); h owever, such lesions did not seem specific to the disease and were not statistically correlated with the degree of esophageal varices by Chi ld's grading, the etiology of cirrhosis, or the bleeding risk from the lower gastrointestinal tract.