PORTAL HYPERTENSIVE COLOPATHY - A NEW ENTITY

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 (greater-than-or-equal-to 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-mu-m vs 18.7 +/- 1.6-mu-m, P < 0.05) and a higher mean cross-sectional vascular area (2143 +/- 396-mu-m2 vs 1676 +/- 345-mu-m2, 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.