Chandrasekar T S, Janakan Gokul Bollu, Chandrasekar Viveksandeep Thoguluva, Kalamegam Raja Yogesh, Suriyanarayanan Sathiamoorthy, Sanjeevaraya Prasad Menta
Medindia Institute of Medical Specialities, 83, Valluvar Kottam High Road, Nungambakkam, Chennai, 600 034, India.
Indian J Gastroenterol. 2017 Jan;36(1):32-37. doi: 10.1007/s12664-016-0721-5. Epub 2017 Jan 9.
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.
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.
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.
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 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables.
Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.
小肠异位静脉曲张出血以及门静脉高压性肠病（PHE）所致的持续性贫血极具挑战性。胶囊内镜检查（CE）是识别此类病变的最佳无创检查方法之一。
本研究旨在探讨与门静脉高压（PHT）相关的小肠病变的患病率，并将其与食管、胃和结肠门静脉高压影响的观察结果进行关联分析。
纳入32例因各种病因导致PHT且伴有贫血或胃肠道出血的患者，以及年龄和性别匹配的无PHT的对照者。所有患者均接受血液检查、胃镜检查、结肠镜检查和CE检查。CE检查发现的小肠病变分为炎症样病变和血管病变。分析小肠病变情况，以找出其与各种人口统计学、临床和内镜变量之间的关联。
32例PHT患者中有31例（96.8%）经CE检查确诊为PHE。其中，31例（96.8%）表现为炎症样外观，11例（34.4%）有血管病变，2例（6.2%）有小肠静脉曲张。8例（25%）对照者出现炎症样外观，2例（6.2%）出现血管发育异常病变。96.8%的患者和25%的对照者检测到与PHE相符的结果（X² =34.72，p=0.000）。PHE的存在与上述任何变量均无关联。
贫血的PHT患者小肠黏膜病变的发生率明显更高。
