Title: Endoscopic and Histopathologic Features in Patients of Portal Hypertensive Duodenopathy
Authors: Dr Anil Sharma, Dr Mamta Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.111
Abstract
Objective: The aim of study is to describe the frequency of PHD in portal hypertension patients and its various clinical, endoscopic and histopathologic features.
Methods: Ninety four patients with cirrhosis and portal hypertention were studied. Two duodenal biopsies from first and second part were obtained during upper endoscopy and sent for histopathologic examination. Twenty five dyspeptic patients were taken as control.
Results: Endoscopic changes in duodenum during upper GI endoscopy were seen in 52 patients out of 94 patient (55.3%). These changes include erythema, erosion, ulcer and telangiectasia. Extending duodenal lesions were significantly higher in decompensated than in compensated cirrhotic patients. Erythema was the commonest lesion. ED (endoscopic duodenopathy) was significantly higher in patients of severe gastropathy (60.7%) than mild gastropathy (26.6%). Endoscopic Duodenopathy (ED) bleed was seen in 7.4%. ED was not related to variceal size and variceal bleed. Histopathologic changes includes capillary congestion, edema, apoptosis, fibrous changes and inflammation. These Histopathologic changes were not statistically significant between patients with or without ED.
Conclusion: Portal hypertensive duodenopathy is not related to variceal size or variceal bleeding but it is significantly higher in patient having severe gastropathy. Portal hypertensive duodenopathy can be a cause of overt or obscure bleeding. Histopathologic duodenopathy is more prevalent than endoscopic duodenopathy.
References
- . T. McCormack, J. Sims, I. Eyre-Brook et al., “Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?”Gut, vol. 26, no. 11, pp. 1226–1232, 1985.
- Vigneri, R. Termini, A. Piraino et al., “The duodenum in liver cirrhosis: endoscopic, morphological and clinical findings,”Endoscopy, vol. 23, no. 4
- S. Nagral, A. S. Joshi, S. J. Bhatia, P. Abraham, F. P. Mistry, and I. M. Vora, “Congestive jejunopathy in portal hypertension,” Gut, vol. 34, no. 5, pp. 694–697, 1993.
- P. Misra, M. Dwivedi, V. Misra, and M. Gupta, “Ileal varices and portal hypertensive ileopathy in patients with cirrhosis and portal hypertension,” Gastrointestinal Endoscopy, vol. 60, no. 5, pp. 778–783, 2004.
- D. de Palma, M. Rega, S. Masone et al., “Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study,” Gastrointestinal Endoscopy, vol. 62, no. 4,
- A. Kozarek, V. A. Botoman, J. E. Bredfeldt, J. M. Roach, D. J. Patterson, and T. J. Ball, “Portal colopathy: prospective study of colonoscopy in patients with portal hypertension,”Gastroenterology, vol. 101, no. 5, pp. 1192–1197, 1991
- Barakat, M. Mostafa, Z. Mahran, and A. G. Soliman, “Portal hypertensive duodenopathy: clinical, endoscopic, and histopathologic profiles,”American Journal of Gastroenterology, vol. 102, no. 12, pp. 2793–2802, 2007.
- Misra, S. P. Misra, M. Dwivedi, and S. C. Gupta, “Histomorphometric study of portal hypertensive enteropathy,” American Journal of Clinical Pathology, vol. 108, no. 6, pp. 652–657, 1997.
- Pugh RNH, Murray-Lyon JM, Dawson JL, et al. Transection of oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–9.
- Menchen L, Ripoli C, Martin-Jimenez I, et al. Prevalence of portal hypertensive duodenopathy in cirrhosis: Clinical and haemodynamic features. Eur Gastroenterol Hepatol 2006;18:649–53.
- Boron-Kaczmarzka A, Hryniewicz A, Kemona A, et al. Morphologic changes of small intestine epithelium in the course of post-alcoholic liver cirrhosis. Drug Alcohol Depend 1990;25:299–303
- Gupta R, Saraswat VA, Kumar M, et al. Frequency and factor influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension. J Gastroenterol Hepatol 1996;11:728–33.
- Desai N, Desai D, Pethe V, et al. Portal hypertensive jejunopathy: A case control study. Indian J Gastroenterol 2004;23:99–101
- Santoro GA, Aiello C, Galloro G, et al. Massive lower gastrointestinal haemorrhage in patients with portal hypertensive enteropathy: A report of two cases. Hepatogastroenterology 1997;44: 1029–32.