ALTERATIONS IN COLONIC MUCOSAL VESSELS IN PATIENTS WITH CIRRHOSIS ANDNONCIRRHOTIC PORTAL-HYPERTENSION

Changes in intestinal mucosal microvasculature as a cause of lower gas trointestinal hemorrhage in patients with portal hypertension have bee n well documented clinically, but the analogous histomorphological cha nges have not been well characterized. The goal of this study was to e valuate qualitative and quantitative changes in colonic mucosal vessel s in patients with cirrhosis or clinically evident portal hypertension and to correlate these changes with endoscopic and clinical findings. Colon biopsy or resection specimen slides from 46 patients with biops y-proven cirrhosis (44 patients) or noncirrhotic portal hypertension ( two patients) were reviewed. Immunoperoxidase stain for CD34 antigen w as used to facilitate visualization of mucosal vessels, and vessel dia meter Has measured with a micrometer. Patients with inflammatory bowel disease were excluded. Twenty-four normal colon biopsy specimens serv ed as controls. Mucosal vessels were divided into superficial, interme diate, and deep layers. As a group, the cirrhotic patients had a signi ficantly higher mean diameter of vessels in all three layers, Qualitat ively, increased numbers of small vessels and prominent branching were noted, especially in the superficial and intermediate layers. Tortuou s, thick-walled vessels, suggesting arterialization of venules, were p resent in some cases. Eleven patients had endoscopic findings suggesti ve of vascular abnormalities, including erythematous mucosal patches, red macules, and telangiectasias. Eighteen had esophageal varices, and five had portal gastropathy. Nineteen patients had gastrointestinal ( GI) bleeding, localized to the lower GI tract in 11. These qualitative and quantitative findings suggest that colonic mucosal vascular lesio ns are common in portal hypertension and may represent a potential sou rce of clinically significant lower GI hemorrhage in these patients. C opyright (C) 1998 by W.B. Saunders Company.