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Controlled Clinical Trial
. 2008 May;22(5):469-74.
doi: 10.1155/2008/534871.

Capsule endoscopy in the investigation of patients with portal hypertension and anemia

Spyros Goulas  1 , Konstantina Triantafyllidou, Stephanos Karagiannis, Panayiota Nicolaou, Petros Galanis, Irene Vafiadis, Michael Tzivras, Christos Mavrogiannis
Affiliations
Controlled Clinical Trial

Capsule endoscopy in the investigation of patients with portal hypertension and anemia

Spyros Goulas et al. Can J Gastroenterol. 2008 May.

Abstract
in English, French

Introduction: Data on small bowel abnormalities in patients with portal hypertension (PHT) are limited. Bleeding from the gastrointestinal tract and anemia are common complications in these patients. Capsule endoscopy (CE) was used to evaluate small bowel (SB) pathology in patients with PHT and anemia, and possible associations with various parameters were examined.

Methods: Thirty-five patients with PHT referred for CE investigation of the SB for anemia were prospectively enrolled in the study, as well as 70 age- and sex-matched control patients with anemia, normal liver function and no evidence of PHT who underwent CE.

Results: Findings compatible with portal hypertensive enteropathy (PHE) were detected in 65.7% of the patients and in 15.7% of the controls chi2=26.641, P=0.000). Abnormalities in PHT patients included varices in 25.7%, diffuse changes of mucosa with inflammatory-like appearance in 42.9%, and angiodysplasias and/or spider angiomas in 22.9% of cases. The presence of PHE was significantly associated only with the presence of severe portal hypertensive gastropathy, while the presence of SB varices alone was significantly associated with the presence of severe portal hypertensive gastropathy, larger esophageal varices and the presence of colonic varices.

Conclusions: Varices, diffuse changes of mucosa with inflammatory-like appearance, and angiodysplasias and/or spider angiomas are detected more often in patients with PHT than in controls, and probably constitute the endoscopic characteristics of PHE. CE of the SB added a significant number of likely important findings to those detected by conventional endoscopic techniques for the clinical management of patients with PHT and anemia.

INTRODUCTION :: Les données sur les anomalies de l’intestin grêle chez les patients souffrant d’hypertension portale (HTP) sont limitées. Les saignements du tractus digestif et l’anémie sont des complications fréquentes chez ces patients. L’endoscopie par capsule (EC) a permis d’é-valuer la pathologie du grêle chez des patients atteints d’HTP et les liens possibles avec divers paramètres ont été analysés.

MÉTHODE :: Trente-cinq patients atteints d’HTP adressés pour EC du grêle en raison d’anémie ont été inscrits de manière prospective à l’étude, de même que 70 patients témoins, assortis selon l’âge et le sexe, atteints d’anémie, mais ne présentant aucune dysfonction hépatique ni signe d’HTP et ayant subi une EC.

RÉSULTATS :: On a noté des signes d’entéropathie hypertensive portale (EHP) chez 65,7 % des patients et chez 15,7 % des témoins (χ2 = 26,641, p = 0,000). Les anomalies observées chez les patients atteints d’HTP incluaient : varices chez 25,7 %, anomalies diffuses de la muqueuse avec signes pseudo-inflammatoires chez 42,9 % et angiodysplasies et/ou angiomes stellaires chez 22,9 %. La présence d’EHP a été significativement associée uniquement à la présence de gastropathie hypertensive portale sévère, tandis que la présence de varices au niveau du grêle seulement a été significativement associée à la gastropathie hypertensive portale sévère, à la présence de varices œsophagiennes plus volumineuses et à la présence de varices au niveau du côlon.

CONCLUSION :: Les varices, les anomalies diffuses de la muqueuse d’aspect pseudo-inflammatoire et les angiodysplasies et/ou angiomes stellaires s’observent plus souvent chez les patients atteints d’HTP que chez les témoins et constituent probablement les caractéristiques endoscopiques de l’EHP. L’EC du grêle a révélé un nombre significatif de caractéristiques probablement importantes en plus des signes mis au jour par les techniques endoscopiques habituelles pour la prise en charge clinique des patients qui souffrent d’HTP et d’anémie.

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Figures

Figure 1)
Figure 1)
Jejunal varix in a patient with portal hypertension
Figure 2)
Figure 2)
Ileal varix in a patient with portal hypertension
Figure 3)
Figure 3)
Portal hypertensive enteropathy in the ileum of a patient with portal hypertension
Figure 4)
Figure 4)
Portal hypertensive enteropathy and a varix in the jejunum of a patient with portal hypertension
See this image and copyright information in PMC

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