Abstract
The aim of this paper was, first, to show in a case control study that in alcoholic cirrhotic patients colonic vascular ectasias (VE) are a complication of portal hypertension and, second, to establish in a histomorphometric study that colonic vascular ectasias and rectal varices (RV) are only endoscopic features of a new entity: portal hypertensive colopathy, the pathologic basis of which is colonic mucosal capillary ectasia. In the case control study, for each case, three age- and sex-matched controls selected from consecutive patients were used. Sixteen alcoholic cirrhotic patients, 12 men, 4 women (mean age ±sd: 62±10 years) had colonic vascular ectasias. The prevalence of esophageal varices (88% vs 44%,P<0.005), esophageal varices (≥5 mm) (44% vs 12.5%,P<0.01), previous history of bleeding from esophageal varices (44% vs 8%,P<0.005), and rectal varices (63% vs 6%,P<0.001) was significantly greater in cases with colonic vascular ectasias than in controls without colonic vascular ectasias. The relative risk of colonic vascular ectasias in alcoholic cirrhotic patients with esophageal varices versus cirrhotic patients without esophageal varices was 14.4 (95% confidence interval 2.8–75.3). In the histomorphometric study, cirrhotic patients with vascular ectasias and/or rectal varices had a significantly higher mean diameter of vessels (20.3±1.5 μm vs 18.7±1.6 μm,P<0.05) and a higher mean cross-sectional vascular area (2143±396 μm2 vs 1676±345 μm2,P<0.05) than cirrhotic patients without vascular ectasias and/or rectal varices. These results suggest that colonic vascular ectasias seem to be a complication of portal hypertension and that colonic vascular ectasias and rectal varices are endoscopic features of a new entity the portal hypertensive colopathy.
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References
Harford WV: Gastrointestinal angiodysplasia: Clinical features. Endoscopy 20:144–148, 1988
Boley SJ, Brandt LU: Vascular ectasias of the colon. Dig Dis Sci 31:26S-42S, 1986
Mc Cormack TT, Sims J, Eyre-Brook I, Kennedy H, Goepel J, Johnson AG, Triger DR: Gastric lesions in portal hypertension: Inflammatory gastritis or congestive gastropathy? Gut 26:1226–1232, 1985
Quintero E, Pique JM, Bombi JA, Bordas JM, Sentis J, Montserrat E, Bosch J, Rodes J: Gastric mucosal vascular ectasias causing bleeding in cirrhosis. Gastroenterology 93:1054–1061, 1987
Poynard T, Aubert A, Naveau S, Bedossa P, Abella A, Chaput JC: A computer protocol to predict liver cirrhosis in drinkers. J Hepatol 7:S70, 1988 (abstract)
Rogers BHG: Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular and pulmonary diseases. Gastrointest Endosc 26:134–138, 1980
Howard OM, Buchanan JD, Hunt RH: Angiodysplasia of the colon. Experience of 26 cases. Lancet 2:16–19, 1982
Shah A: Angiodysplasia morphologic diagnosis. Endoscopy 20:149–151, 1988
Miettinen OS: Estimation of relative risk from individually matched series. Biometrics 26:75–86, 1979
Manning AP, Thomson WG, Heaton KW, Morris AF: Towards positive diagnosis of the irritable bowel. Br Med J 2:653–654, 1978
Naveau S, Chaput JC, Bedossa P, Poynard T, Pauphilet C, Ink O, Houdayer C, Aubert A: Cirrhosis as independent risk factor for colonic adenomas (in press)
Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973
Feinstein AR, Horwitz RI: Methodologic standards and contradictory results in case-control research. Am J Med 66:556–563, 1979
Poynard T, Chaput JC: Facteurs de risque des hémorragies digestives par rupture de varices oesophagiennes.In Hypertension Portale, Progrès en Hépatogastroentérologie. Doin (ed). Paris, 1989, pp 131–142
Pascal JP, Cales P, Multicenter Study Group: Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 317:856–861, 1987
Lebrec D, Benhamou JP: Ectopic varices in portal hypertension. Clin Gastroenterol 14:105–121, 1985
Hill MC, Dach JL, Shawk ER: Ultrasonography portal hypertension. Clin Gastroenterol 14:83–104, 1985
Zuckerman GR, Cornette GL, Clouse RE, Harter HB: Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 102:588–592, 1985
Imperiale TF, Ransohoff DF: Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: Is there an association? Gastroenterology 95:1670–1676, 1988
Naveau S, Poynard T, Pauphilet C, Aubert A, Chaput JC: Rectal and colonic varices in cirrhosis. Lancet 1:624, 1989 (letter)
Kozarek RA, Botoman VA, Bredfeldt JE, Roach JM, Patterson DJ, Ball TJ: Portal colopathy: Prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 99:A599, 1990 (abstract)
Rabinovitz M, Schade RR, Dindzan SVJ, Belle SH, Van Thiel DH, Gavaler JS: Colonic disease in cirrhosis. An endoscopic evaluation in 412 patients. Gastroenterology 99:195–199, 1990
Naveau S, Aubert A, Poynard T, Chaput JC: Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodynium-YAG laser photocoagulation. Dig Dis Sci 35:821–826, 1990
Perez-Ayuso RM, Pique JM, Bosch J, Panes J, Gonzalez A, Perez R, Rigau J, Quintero E, Valderrama R, Viver J, Esteban R, Rodrigo L, Bordas JM, Rodes J: Propranol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet 2:1431–1434, 1991
Szabo S, Trier JS, Brown A, Schnoor J: Early vascular injury and increased vascular permeability in gastric mucosa injury caused by ethanol in the rat. Gastroenterology 88:228–236, 1985
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Naveau, S., Bedossa, P., Poynard, T. et al. Portal hypertensive colopathy. Digest Dis Sci 36, 1774–1781 (1991). https://doi.org/10.1007/BF01296624
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DOI: https://doi.org/10.1007/BF01296624