Ileal varices and portal hypertensive ileopathy in patients with cirrhosis and portal hypertension

Misra, Sri Prakash; Dwivedi, Manisha; Misra, Vatsala; Gupta, Manisha

doi:10.1016/s0016-5107(04)02049-8

Cited by 56 publications

(47 citation statements)

References 29 publications

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“…Given these results, we agree with JimenezSaenz et al [30] that enteroscopy should be reserved for patients who present obscure digestive bleeding. Capsule enteroscopy should be the preferred method firstly because, by allowing complete examination of the small bowel, it is obviously more efficient in detecting small bowel manifestations of PTH than other diagnostic modalities, for example retrograde ileoscopy [23,24], and, second, accurate diagnosis may enable therapeutic intervention with double-balloon enteroscopy, as occurred in our patient. The relationship between previous esophageal endoscopic treatment and the existence of PHG and PHC is discussed in the literature.…”

Section: Discussionmentioning

confidence: 80%

“…Congestive gastroenteropathy has been reported to be a non-variceal cause of bleeding in patients with PTH [15,20], but most of the studies on portal hypertensive enteropathy (PHE) found in the literature were obtained by upper endoscopy [15,20], by push enteroscopy [22], or by retrograde ileoscopy at colonoscopy [23,24], and only include the duodenum, proximal jejunum, and terminal ileum.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

et al. 2007

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Background and aim The effects of portal hypertension in the small bowel are largely unknown. The aim of the study was to prospectively assess portal hypertension manifestations in the small bowel. Methods We compared, by performing enteroscopy with capsule endoscopy, the endoscopic findings of 36 patients with portal hypertension, 25 cirrhotic and 11 non-cirrhotic, with 30 controls. Results Varices, defined as distended, tortuous, or saccular veins, and areas of mucosa with a reticulate pattern were significantly more frequent in patients with PTH. These two findings were detected in 26 of the 66 patients (39%), 25 from the group with PTH (69%) and one from the control group (3%) (P \ 0.0001). Among the 25 patients with PTH exhibiting these patterns, 17 were cirrhotic and 8 were non-cirrhotic (P = 0.551). The presence of these endoscopic changes was not related to age, gender, presence of cirrhosis, esophageal or gastric varices, portal hypertensive gastropathy, portal hypertensive colopathy, prior esophageal endoscopic treatment, current administration of beta-blockers, or Child-Pugh Class C. More patients with these endoscopic patterns had a previous history of acute digestive bleeding (72% vs. 36%) (P = 0.05). Active bleeding was found in two patients (5.5%). Conclusions The presence of varices or areas of mucosa with a reticulate pattern are manifestations of portal hypertension in the small bowel, found in both cirrhotic and non-cirrhotic patients. The clinical implications of these findings, as regards digestive bleeding, are uncertain, although we documented acute bleeding from the small bowel in two patients (5.5%).

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

et al. 2007

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“…Portal congestive jejunopathy is defined histologically by the presence of ectatic capillaries and venules in the villi, with an increase in the number of vessels to > 6/villus [274] . Portal hypertensive ileopathy [275] , and portal hypertensive colopathy [38,276] are also associated with portal hypertension. The colopathy histologically appears as dilatation of mucosal blood vessels and is classified into four different types by Ito et al [38] , including solitary vascular ectasias, diffuse vascular ectasias, erythema, and blue vein.…”

Section: Preventionmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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“…Terminal ileoscopy is an integral part of complete colonoscopy. Retrograde terminal ileoscopy has been noted to be useful in patients with inflammatory bowel disease, diarrhea, lymphoma, cytomegalovirus induced ileitis, tuberculosis, portal hypertension and a host of other conditions involving the terminal ileum [21][22][23][24][25][26][27][28][29][30][31][32][33][34] . In a recent study, it has been noted that obtaining blind biopsies from even a normal-appearing terminal ileum is useful in patients suspected to have ileocaecal tuberculosis [35] .…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, ileal tuberculosis was noted to be the cause of bleeding in one of the patients [36] . However, despite being recommended by several authors [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] terminal ileoscopy is not routinely performed on all patients undergoing colonoscopy [37,38] . However; routine retrograde ileoscopy is very useful and easy to perform after imparting proper training [38] .…”

Section: Introductionmentioning

confidence: 99%