Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study

Background: Controversy still exists regarding colonic mucosal abnormalitie s in patients with portal hypertension (portal colopathy). The:aims of this study were to better define portal colopathy and to identify risk factors for these colonic mucosal abnormalities. Methods: We reviewed the medical records of 437 patients with cirrhosis and portal hypertension and 224 with irritable bowel syndrome (control patient s) who underwent colonoscopy over a 6-year period. Results: Individuals with portal hypertension were significantly more likel y than control patients to have colitis-like abnormalities (38% vs. 3%, p < 0.001) and vascular lesions (13% vs. 3%, p < 0.001). In the multivariate m odel, portal hypertensive gastropathy (odds ratio 5.64: 95% CI [3.39, 9.41] ; p < 0.001), 2+ or larger esophageal varices (odds ratio 4.76: 95% CI [2.7 8, 8.15]; p < 0.001), and Child-Pugh class C cirrhosis (odds ratio 2.64: 95 % CI [1.40, 4.97]; p = 0.003) were independently associated with an increas ed risk of having portal colopathy, whereas the use of beta-blockers indepe ndently decreased the risk of having these findings (odds ratio 0.23: 95% C I [0.13, 0.40]; p < 0.001). Mucosal biopsies of the colon in patients with colitis-like abnormalities revealed a mild, nonspecific inflammatory infilt rate with edema and vascular ectasias in the majority of cases. Conclusions: Mucosal abnormalities in portal colopathy include edema, eryth ema, granularity, friability, and vascular lesions, findings that may be co nfused with colitis. A standardized grading system to classify the endoscop ic appearance and severity of portal colopathy should be adopted.