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

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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.

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Authors and Affiliations

  1. Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India

    T. S. Chandrasekar, Gokul Bollu Janakan, Viveksandeep Thoguluva Chandrasekar, Raja Yogesh Kalamegam, Sathiamoorthy Suriyanarayanan & Prasad Menta Sanjeevaraya

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  1. T. S. Chandrasekar
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  2. Gokul Bollu Janakan
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  3. Viveksandeep Thoguluva Chandrasekar
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  4. Raja Yogesh Kalamegam
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  5. Sathiamoorthy Suriyanarayanan
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  6. Prasad Menta Sanjeevaraya
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Correspondence to T. S. Chandrasekar.

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Conflict of interest

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

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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

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Chandrasekar, T.S., Janakan, G.B., Chandrasekar, V.T. et al. Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology. Indian J Gastroenterol 36, 32–37 (2017). https://doi.org/10.1007/s12664-016-0721-5

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  • DOI: https://doi.org/10.1007/s12664-016-0721-5

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