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Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
Published on: August 1, 2018
Portal hypertensive colopathy and haematochezia in cirrhotic patients: an endoscopic study
1Internal Medicine, Hepatogastroenterology Unit, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt. Yahiazgad@yahoo.com
Insights
In cirrhotic patients with lower GI bleeding, colonoscopy revealed portal hypertensive colopathy (PHC) is associated with liver disease severity. However, inflammatory lesions were more prevalent, highlighting the need for complete colonoscopy to rule out other causes.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopy
Background:
- Portal hypertensive colopathy (PHC) and anorectal varices (ARVs) are implicated in lower gastrointestinal (GI) bleeding in liver cirrhosis patients.
- Understanding the diagnostic yield of colonoscopy is crucial for managing haematochezia in this population.
Purpose of the Study:
- To evaluate the diagnostic yield of colonoscopy in cirrhotic patients presenting with haematochezia.
- To assess the association between PHC and other clinical factors in cirrhotic patients with lower GI bleeding.
Main Methods:
- A prospective study of 77 consecutive cirrhotic patients undergoing colonoscopy.
- Detailed patient history, physical examination, and laboratory investigations were performed.
- Colonoscopic findings, including abnormalities and biopsies, were recorded.
Main Results:
- PHC was significantly associated with Child-Pugh class, splenectomy history, prior variceal treatments, upper GI bleeding, gastric varices, portal hypertensive gastropathy, hemorrhoids, rectal varices, and beta-blocker therapy.
- Platelet count was markedly reduced in the PHC-positive group.
- PHC-related bleeding sources (21.87%) were successfully managed with argon plasma coagulation.
Conclusions:
- While PHC is associated with haematochezia in cirrhotic patients, inflammatory lesions are more frequently observed.
- Complete colonoscopy is essential for detecting potential proximal neoplastic lesions in cirrhotic patients with lower GI bleeding.
Background And Study Aims:
In patients with liver cirrhosis, portal hypertensive colopathy (PHC) and anorectal varices (ARVs) are thought to cause lower gastrointestinal (GI) bleeding. In the present work, we studied the diagnostic yield of colonoscopy in cirrhotic patients and haematochezia.
Patients And Methods:
The current study was conducted on 77 consecutive cirrhotic patients who underwent colonoscopy at Mansoura Emergency Hospital, Egypt, between May 2007 and May 2011. Following rapid evaluation and adequate resuscitation, a thorough history was obtained with complete physical examination including digital rectal examination and routine laboratory investigations. Colonoscopic evaluation was performed for the included patients by recording endoscopic abnormalities and obtaining biopsies from lesions.
Results:
There was no significant difference between the PHC-positive group when compared with the PHC-negative group regarding patients' age, sex, severity of haematochezia, positive family history and the history of intake of non-steroidal anti-inflammatory drugs (NSAIDs). Significant difference was noted regarding the Child-Pugh class (p<0.05), history of splenectomy (p<0.05), prior history of endoscopic sclerotherapy (EST) or endoscopic variceal ligation (EVL) (p<0.05), prior history of upper gut bleeding (p<0.05), the presence of gastric varices (GVs) (p<0.05), presence of portal hypertensive gastropathy (PHG) (p<0.05), presence of haemorrhoids (p<0.05) and rectal varices (<0.05) and therapy with β-blockers (p<0.05). Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p<0.05). All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation. Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p<0.05). All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation.
Conclusion:
Our data revealed that it is not only PHC which is involved in haematochezia in cirrhotic patients despite the significant association. Instead, a high prevalence of inflammatory lesions came on the top of the list. Complete colonoscopy is highly advocated to detect probable proximal neoplastic lesions.
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