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Indian Journal of Gastroenterology

, Volume 36, Issue 1, pp 32–37 | Cite as

Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology

  • T. S. ChandrasekarEmail author
  • Gokul Bollu Janakan
  • Viveksandeep Thoguluva Chandrasekar
  • Raja Yogesh Kalamegam
  • Sathiamoorthy Suriyanarayanan
  • Prasad Menta Sanjeevaraya
Original Article

Abstract

Background

Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions.

Aim

The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon.

Methods

Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables.

Results

Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables.

Conclusions

Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.

Keywords

Anemia Capsule endoscopy Ectopic varices Gastrointestinal bleeding Portal hypertension Portal hypertensive enteropathy 

Notes

Compliance with ethical standards

Conflict of interest

TSC, GBJ, VTC, RYK, SS, and PMS declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com

References

  1. 1.
    Goulas S, Triantafyllidou K, Karagiannis S, et al. Capsule endoscopy in the investigation of patients with portal hypertension and anemia. Can J Gastroenterol. 2008;22:469–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Practice guidelines committee of the american association for the study of liver diseases; practice parameters committee of the american college of gastroenterology.Google Scholar
  3. 3.
    Cremers I, Ribeiro S. Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis. Therap Adv Gastroenterol. 2014;7:206–16.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Viggiano TR, Gostout CJ. Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features. Am J Gastroenterol. 1992;87:944–54.PubMedGoogle Scholar
  5. 5.
    Friedman S. Comparison of capsule endoscopy to other modalities in small bowel. Gastrointest Endosc Clin N Am. 2004;14:51–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Tang SJ, Zanati S, Dubcenco E, et al. Diagnosis of small-bowel varices by capsule endoscopy. Gastrointest Endos. 2004;60:129–35.Google Scholar
  7. 7.
    De Palma GD, Rega M, Masone S, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc. 2005;62:529–34.Google Scholar
  8. 8.
    Abdelaal UM, Morita E, Nouda S, et al. Evaluation of portal hypertensive enteropathy by scoring with capsule endoscopy: is transient elastography of clinical impact? J Clin Biochem Nutr. 2010;47:37–44.Google Scholar
  9. 9.
    Jeon SR, Kim JO, Kim JB, et al. Portal hypertensive enteropathy diagnosed by capsule endoscopy in cirrhotic patients: a nationwide multicenter study. Dig Dis Sci. 2014;59:1036–41.Google Scholar
  10. 10.
    Rondonotti E, Villa F, Dell' Era A, Tontini GE, de Franchis R. Capsule endoscopy in portal hypertension. Clin Liv Dis. 2010;14:209–20.Google Scholar
  11. 11.
    de Franchis R, Pascal JP, Ancona E, et al. Definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 1992;15:256–61.Google Scholar
  12. 12.
    McCormack TT, Sims J, Eyre-Brook I, et al. Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut. 1985;26:1226–32.Google Scholar
  13. 13.
    Hartmann D, Eickhoff A, Damian U, Riemann JF. Diagnosis of small-bowel pathology using paired capsule endoscopy with two different devices: a randomized study. Endoscopy. 2007;39:1041–5.Google Scholar
  14. 14.
    Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn! Indian J Gastroenterol. 2008;27:74–80.PubMedGoogle Scholar
  15. 15.
    Martell M, Coll M, Ezkurdia N, Raurell I, Genescà J. Physiopathology of splanchnic vasodilation in portal hypertension. World J Hepatol. 2010;2:208–20.Google Scholar
  16. 16.
    Nagral AS, Joshi AS, Bhatia SJ, Abraham P, Mistry F, Vora IM. Congestive jejunopathy in portal hypertension. Gut. 1993;34:694–7.Google Scholar
  17. 17.
    Desai N, Desai D, Pethe V, Deodhar KP, Sawant P, Nanivadekar S. Portal hypertensive jejunopathy: a case control study. Indian J Gastroenterol. 2004;23:99–101.PubMedGoogle Scholar
  18. 18.
    Misra SP, Dwivedi M, Misra V, Gupta M. Ileal varices and portal hypertensive ileopathy in patients with cirrhosis and portal hypertension. Gastrointest Endosc. 2004;60:778–83.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2017

Authors and Affiliations

  • T. S. Chandrasekar
    • 1
    Email author
  • Gokul Bollu Janakan
    • 1
  • Viveksandeep Thoguluva Chandrasekar
    • 1
  • Raja Yogesh Kalamegam
    • 1
  • Sathiamoorthy Suriyanarayanan
    • 1
  • Prasad Menta Sanjeevaraya
    • 1
  1. 1.Medindia Institute of Medical SpecialitiesChennaiIndia

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