Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

Portal hypertensive colopathy in Egyptian cirrhotic patients: an endoscopic study

The Egyptian Journal of Internal Medicine volume 30, pages 249–254 (2018)Cite this article

Abstract

Background

Hepatitis C virus (HCV) infection is a major health problem in Egypt. It is often complicated by liver cirrhosis and portal hypertension, resulting in gastroesophageal varices, gastropathy, and colopathy. However, there is still lack of data with respect to the prevalence and clinical relevance of colopathy in this kind of liver disease. The aim of this study was to determine the prevalence of colopathic lesions in HCV-related cirrhotic patients, and to study their associations with the severity of liver disease and manifestations of portal hypertension

Patients and methods

This cross-sectional study included 60 patients with liver cirrhosis who were submitted to thorough clinical, laboratory, and ultrasonographic examinations. In addition, both upper and lower gastrointestinal endoscopy were performed to detect portal hypertensive complications including colopathic lesions. According to their severity, colopathic lesions were graded into three grades. Patients with higher colopathic grading (grade 2 and 3) were compared with the remaining participants with respect to the severity of the liver disease and other manifestations of portal hypertension.

Results

The prevalence of colopathy in cirrhotic patients with underlying HCV etiology was 91%. Patients with higher grades of colopathy were characterized by more severe liver disease. Moreover, they had increased frequency of both esophageal and gastric varices, and prior sclerotherapy or band ligation, as well as more collaterals and gastropathy, and higher grades of esophageal varices.

Conclusion

Colopathic lesions are frequent in patients with HCV-induced cirrhosis. Getting endoscopic treatment for varices is a risk factor for developing higher grades of colopathy. The latter could be considered as a marker of a worse prognosis in patients with HCV cirrhosis.

References

  1. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016; 388:1081–1088.

    Article  Google Scholar 

  2. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57:1333–1342.

    Article  Google Scholar 

  3. Hajarizadeh B, Grebely J, Dore GJ. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol 2013; 10:553–562.

    Article  CAS  Google Scholar 

  4. Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt] & and ICF International. Egypt Health Issues Survey 2015. (Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International, 2015). https://dhsprogram.com/pubs/pdf/FR313/FR313.pdf. [Last accessed 2017 Jul 1].

  5. Gostout CJ, Viggiano TR, Balm RK. Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features. Am J Gastroenterol 1993; 88:2030–2033.

    CAS  PubMed  Google Scholar 

  6. Urrunaga NH, Rockey DC. Portal hypertensive gastropathy and colopathy. Clin Liver Dis 2014; 18:389–406.

    Article  Google Scholar 

  7. Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009; 6:637.

    Article  Google Scholar 

  8. Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989; 1:349–352.

    Article  CAS  Google Scholar 

  9. Bresci G, Parisi G, Capria A. Clinical relevance of colonic lesions in cirrhotic patients with portal hypertension. Endoscopy 2006; 38:830–835.

    Article  CAS  Google Scholar 

  10. Gomez EV, Rodriguez YS, Bertot LC, Gonzalez AT, Perez YM, Soler EA, et al. The natural history of compensated HCV-related cirrhosis: a prospective long-term study. J Hepatol 2013; 58:434–444.

    Article  Google Scholar 

  11. Gatta A, Sacerdoti D, Bolognesi M, Merkel C. Portal hypertension: state of the art. Ital J Gastroenterol Hepatol 1999; 31:326–345.

    CAS  PubMed  Google Scholar 

  12. Lefton HB, Rosa A, Cohen M. Diagnosis and epidemiology of cirrhosis. Med Clin North Am 2009; 93:787–799.

    Article  CAS  Google Scholar 

  13. De Franchis R. Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33:846–852.

    Article  Google Scholar 

  14. Bini EJ, Lascarides CE, Micale PL, Weinshel EH. Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study. Gastrointest Endosc 2000; 52:511–516.

    Article  CAS  Google Scholar 

  15. Naveau S, Bedossa P, Poynard T, Mory B, Chaput JC. Portal hypertensive colopathy. A new entity. Dig Dis Sci 1991; 36:1774–1781.

    Article  CAS  Google Scholar 

  16. Kozarek RA, Botoman VA, Bredfeldt JE, Roach JM, Patterson DJ, Ball TJ. Portal colopathy: prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 1991; 101:1192–1197.

    Article  CAS  Google Scholar 

  17. Misra SP, Dwivedi M, Misra V. Prevalence and factors influencing hemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Endoscopy 1996; 28:340–345.

    Article  CAS  Google Scholar 

  18. Guimaraes RA, Perazzo H, Machado L, Terra C, Perez RM, Figueiredo FA. Prevalence, variability, and outcomes in portal hypertensive colopathy: a study in patients with cirrhosis and paired controls. Gastrointest Endosc 2015; 82:469–476.

    Article  Google Scholar 

  19. Ito K, Shiraki K, Sakai T, Yoshimura H, Nakano T. Portal hypertensive colopathy in patients with liver cirrhosis. World J Gastroenterol 2005; 11:3127–3130.

    Article  Google Scholar 

  20. Diaz-Sanchez A, Nuñez-Martinez O, Gonzalez-Asanza C, Matilla A, Merino B, Rincon D, et al. Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients. World J Gastroenterol 2009; 15:4781–4787.

    Article  CAS  Google Scholar 

  21. Gad YZ, Zeid AA. Portal hypertensive colopathy and haematochezia in cirrhotic patients: an endoscopic study. Arab J Gastroenterol 2011; 12:184–188.

    Article  Google Scholar 

  22. Yamakado S, Kanazawa H, Kobayashi M. Portal hypertensive colopathy: endoscopic findings and the relation to portal pressure. Intern Med 1995; 34:153–157.

    Article  CAS  Google Scholar 

  23. Chen LS, Lin HC, Lee FY, Hou MC, Lee SD. Portal hypertensive colopathy in patients with cirrhosis. Scand J Gastroenterol 1996; 31:490–494.

    Article  CAS  Google Scholar 

  24. Misra SP, Dwivedi M, Misra V, Dharmani S, Kunwar BK, Arora JS. Colonic changes in patients with cirrhosis and in patients with extrahepatic portal vein obstruction. Endoscopy 2005; 37:454–459.

    Article  CAS  Google Scholar 

  25. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33:464–470.

    Article  CAS  Google Scholar 

  26. Jeong IB, Lee TH, Lim SM, Ryu KH, Kim YS, Kim SM, et al. Endoscopic findings and clinical significance of portal hypertensive colopathy. Korean J Gastroenterol 2011; 58:332–337.

    Article  Google Scholar 

  27. Murphy SF, Durand M, McMorrow JP, Meaney JF, Guiney M. Portal hypertensive colopathy with pelvic varices presenting as severe lower GI bleed treated with TIPSS. Ir Med J 2018; 111:696.

    CAS  PubMed  Google Scholar 

  28. Jeon SR, Kim JO. Capsule endoscopy for portal hypertensive enteropathy. Gastroenterol Res Pract 2016; 2016:8501394.

    Article  Google Scholar 

  29. Rondonotti E, Villa F, Signorelli C, de Franchis R. Portal hypertensive enteropathy. Gastrointest Endosc Clin N Am 2006; 16:277–286.

    Article  Google Scholar 

  30. Gupta R, Saraswat VA, Kumar M, Naik SR, Pandey R. Frequency and factors influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension. J Gastroenterol Hepatol 1996; 11:728–733.

    Article  CAS  Google Scholar 

  31. Thuluvath PJ, Yoo HY. Portal hypertensive gastropathy. Am J Gastroenterol 2002; 97:2973–2978.

    Article  Google Scholar 

  32. Hosking SW, Kennedy HJ, Seddon I, Triger DR. The role of propranolol in congestive gastropathy of portal hypertension. Hepatology 1987; 7:437–441.

    Article  CAS  Google Scholar 

  33. Branco JC, Carvalho R, Alberto SF, Reis J. Long-acting octreotide is effective in the treatment of portal hypertensive colopathy. Gastroenterol Hepatol 2017; 40:536–537.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Helmy Shalaby

  2. Internal Medicine Department, Faculty of Medicine, Al-Azhar University Hospital, New Damietta, 54517, Egypt

    El-Sayed El-Meghawry, Sabry Al-Azhary, Khaled Nagy Elfayoumy MD & El-Sayed Abo Zeid

Authors
  1. Helmy Shalaby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. El-Sayed El-Meghawry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabry Al-Azhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Khaled Nagy Elfayoumy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. El-Sayed Abo Zeid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khaled Nagy Elfayoumy MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shalaby, H., El-Meghawry, ES., Al-Azhary, S. et al. Portal hypertensive colopathy in Egyptian cirrhotic patients: an endoscopic study. Egypt J Intern Med 30, 249–254 (2018). https://doi.org/10.4103/ejim.ejim_42_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_42_18

Keywords