The frequency of small-bowel mucosal changes in patients with portal hypertension
is not known. The objective of the study is to better define the mucosal abnormalities
of portal hypertensive enteropathy (PHE) and to determine whether these findings are
associated with the severity of liver disease, esophageal varices, portal gastropathy,
portal colonopathy, or other clinical characteristics.
We compared the medical records of 37 patients with cirrhosis and portal hypertension
with 34 control patients who underwent capsule endoscopy over a 3-year period.
Mucosal changes were found to be significantly more common in the cirrhotic patients
than in the control patients (67.5% vs. 0, p < 0.001). The lesions included telangiectasias
or angiodysplastic-like lesions in 9 (24.3%) patients, red spots in 23 (62.2%), and
varices in 3 (8.1%). Active bleeding was seen during endoscopic examinations in 4
(10.8%) patients. A comparison of patients with and those without PHE showed that
grade 2+ or larger esophageal varices, portal gastropathy, portal colonopathy, and
Child-Pugh class C cirrhosis were all significantly associated with PHE. There were
no differences between these two groups of patients with regard to the etiology of
cirrhosis, gender, or history of esophageal variceal bleeding.
Mucosal abnormalities in portal jejunopathy include edema, erythema, and vascular
lesions findings. A standardized grading system to classify the endoscopic appearance
and the severity of portal enteropathy is proposed. The clinical import of these changes
remains to be explained.