Diagnostic and therapeutic features of small bowel involvement in portal hypertension

Valenzuela, Juan Egea; Llamas, Tania Fernández; Marín, Ana Victoria García; Parras, Fernando Alberca de Las; Álvarez, F. Carballo

doi:10.17235/reed.2017.4596/2016

Cited by 3 publications

(9 citation statements)

References 51 publications

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“…Gastroenteropathy is a lesser recognised complication in patients with PH and consists of different changes in the mucosa of the small bowel which result in the appearance of vascular and inflammatory abnormalities. 32 It can be a key factor for the development of anaemia in patients with LC, and recently an easy and non-invasive diagnosis is able to be made by CE. However, it is rarely considered for the management of patients with PH.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of capsule endoscopy in patients with cirrhosis for the diagnosis of upper gastrointestinal lesions and small bowel abnormalities: a study protocol for prospective interventional study

Iwata

Nishikawa

Enomoto

et al. 2017

BMJ Open Gastroenterol

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Introduction and aimsThe role of capsule endoscopy (CE) in patients with liver cirrhosis (LC) has yet to be established; however, it is likely that it will remain a valuable diagnostic modality in several groups of patients with LC. The primary aims of the current prospective interventional study are to examine the prevalence for small bowel lesions and transit time of CE in the gastrointestinal tract in patients with LC with oesophageal varices (EVs) requiring endoscopic therapies.Methods and analysisThe current study will be a single-centre prospective interventional study. Our study participants are LC subjects with portal hypertension who were determined to be necessary for prophylactic endoscopic therapies for EVs. From the view point of safety, patients with gastrointestinal obstruction or fistula or those being suspected of having gastrointestinal obstruction or fistula will be excluded from our study. Patients with implanted medical devices will be also excluded. CE will be performed prior to prophylactic endoscopic therapies in the same hospitalisation and relevant images will be analysed after 8 hours by expert endoscopists. This study will continue to recruit until 50 participants.Ethics and disseminationThis study has received approval from the Institutional Review Board at Hyogo College of Medicine (approval no. 2680). The study protocol, informed assent form and other submitted files were reviewed and acknowledged. Final data will be publicly scattered regardless of the study results. A report releasing study results will be submitted for publication in a suitable journal after being finished in data collection.Trial registration numberUMIN000028433 (https://upload.umin.ac.jp/).

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Section: Discussionmentioning

confidence: 99%

“…However, it is rarely considered for the management of patients with PH. 32–34 Additionally, delay of transit time of CE in the gastrointestinal tract will be expected due to PHG-related decrease in the peristaltic movement. 5 17–19 Thus, there will be urgent need for clarifying these issues.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of capsule endoscopy in patients with cirrhosis for the diagnosis of upper gastrointestinal lesions and small bowel abnormalities: a study protocol for prospective interventional study

Iwata

Nishikawa

Enomoto

et al. 2017

BMJ Open Gastroenterol

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“…Up to now, poor consideration has been given to intestinal consequences of portal hypertension from the radiologic point of view, which mainly relies on the endoscopic approach [11 , 12] .…”

Section: Introductionmentioning

confidence: 99%

Portal hypertensive enteropathy: multimodality assessment through computed tomography and magnetic resonance enterography

Cicero

Aricó

Viola

et al. 2022

Radiology Case Reports

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“…Increased pressure in the portal vein system, including the upper and lower mesenteric veins, leads to degenerative changes in the walls of the small and large intestines. 2,3 At the same time, the earliest changes in enterocytes will manifest through the increase in autoantibodies to intestinal antigens. 4 It has been proven that the percutaneous introduction of cryoprecipitate to the liver tissue stimulates liver regeneration, due to local and general anti-inflammatory and immunomodulatory effects.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Increases in Autoantibody Level Associated with Degenerative Changes in the Intestinal Mucosa in Liver Cirrhosis</p>

Karpova¹,

Russkova²,

Lavrentieva³

2020

CEG

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Background: Portal hypertensive colonopathy is a consequence of portal hypertension that develops in hepatic cirrhosis. Pathological processes occurring in intestinal epithelium cells can be revealed by changes in the autoantibody titers to intestinal antigens. It is important both in diagnosis and in the evaluation of the treatment effectiveness. Purpose: To investigate the effect of portal hypertension in patients with liver cirrhosis on degenerative processes in the walls of the small and large intestines after stimulation of liver regeneration with cryoprecipitate. Methods: Thirty-six patients with liver cirrhosis underwent a procedure for percutaneous introduction of cryoprecipitate into the liver tissue. Before and 1 year after it, all the patients were measured for portal blood flow parameters, performed colonoscopy with biopsy, and determined autoantibodies to intestinal antigens (ItM, SCM) in the blood. Comparative analyses of changes in the large intestine mucosa before and after reducing portal hypertension by stimulating liver regeneration with cryoprecipitate were conducted. Results: Here, we show that the degenerative process in the mucosa of the intestines increases, despite the positive dynamics of portal blood flow parameters after the liver regeneration. Autoantibodies values for the intestine antigens were higher than normal in 22 of the 36 patients after 1 year of introduction of cryoprecipitate into the liver. Morphological analysis of the intestinal wall showed the presence of edema/mucosal atrophy and neutrophilic/lymphocytic-histiocytic infiltration in 28 of the 36 patients. Conclusion: Changes in autoantibodies to intestinal antigens are an informative method for diagnosing colonopathy and enteropathy at early stages, providing the possibility to administer proper timely treatment. Patients with hepatic cirrhosis are recommended to have their intestinal microflora tested and be administered drugs that improve their composition.

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Diagnostic and therapeutic features of small bowel involvement in portal hypertension

Cited by 3 publications

References 51 publications

Efficacy of capsule endoscopy in patients with cirrhosis for the diagnosis of upper gastrointestinal lesions and small bowel abnormalities: a study protocol for prospective interventional study

Efficacy of capsule endoscopy in patients with cirrhosis for the diagnosis of upper gastrointestinal lesions and small bowel abnormalities: a study protocol for prospective interventional study

Portal hypertensive enteropathy: multimodality assessment through computed tomography and magnetic resonance enterography

<p>Increases in Autoantibody Level Associated with Degenerative Changes in the Intestinal Mucosa in Liver Cirrhosis</p>

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