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Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features
1Department of Internal Medicine and Gastroenterology, Mayo Medical School, Rochester, Minnesota.
Abstract:
Over the past decade, awareness of the association between portal hypertension and changes in the intestinal circulation has increased. Most of the observations have been made by endoscopic examination and biopsy of the mucosa. The fundamental pathologic change is a vasculopathy. Portal hypertensive intestinal vasculopathy (PHIV) most often involves the stomach (gastropathy) and can be a common source of bleeding. The significance of small bowel involvement (enteropathy) is unknown. Colon involvement (colopathy) has been associated with bleeding, and mimics inflammatory bowel disease. The reliability of endoscopic appearances and histologic examination in establishing the diagnosis is questionable. Recent observations of other diagnostic modalities and associated physiologic alterations and treatment options are discussed. Further prospective evaluations that use uniform terminology for endoscopic and histologic descriptions are needed to establish criteria for accurate diagnosis and assessment of response to treatment.
Insights
Portal hypertensive intestinal vasculopathy (PHIV) affects the gut, often causing bleeding in the stomach and colon. Further research is needed to accurately diagnose PHIV and assess treatment effectiveness.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Pathology
Background:
- Increased awareness of portal hypertension's impact on intestinal circulation over the last decade.
- Portal hypertensive intestinal vasculopathy (PHIV) is a key pathological change, frequently involving the stomach (gastropathy) and colon (colopathy).
- Gastropathy is a common cause of bleeding; the significance of small bowel (enteropathy) involvement remains unclear.
Purpose of the Study:
- To review current understanding of PHIV, including diagnostic modalities, physiological changes, and treatments.
- To highlight the limitations of current diagnostic methods like endoscopy and biopsy.
- To emphasize the need for standardized terminology and prospective studies for accurate diagnosis and treatment assessment.
Main Methods:
- Review of recent observations on diagnostic modalities for PHIV.
- Discussion of associated physiological alterations.
- Examination of current treatment options for PHIV.
Main Results:
- PHIV commonly affects the stomach and colon, leading to bleeding and mimicking inflammatory bowel disease.
- The diagnostic reliability of endoscopic and histologic examinations is currently questionable.
- Small bowel involvement (enteropathy) in PHIV is not well understood.
Conclusions:
- Standardized endoscopic and histologic descriptions are crucial for accurate PHIV diagnosis.
- Prospective evaluations are necessary to establish diagnostic criteria and assess treatment response.
- Further research is required to clarify the role and impact of PHIV, particularly in the small intestine.