Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
BMC Gastroenterol. 2024 Aug 26;24(1):287. doi: 10.1186/s12876-024-03377-7.
Portal hypertensive enteropathy (PHE) is a small-bowel lesion observed in patients with portal hypertension. The clinical significance of endoscopic findings in PHE remains unclear. We aimed to clarify the clinical significance and predictive factors of capsule endoscopic findings in patients with PHE based on long-term outcomes.
This retrospective study enrolled 55 patients with PHE (33 males and 22 females; median age, 64 years; range, 23-87) followed for > 3 years using capsule endoscopy (CE) between February 2009 and May 2023. We evaluated the clinical factors affecting PHE exacerbations and the effects of PHE exacerbations on gastrointestinal bleeding by comparing exacerbated and unchanged PHE groups.
Overall, 3 (5%) patients showed improvement, 33 (60%) remained unchanged, and 19 (35%) showed exacerbation on follow-up CE. In the exacerbated group, the rates of worsened fibrosis-4 index, exacerbated esophageal varices, and exacerbated portal hypertensive gastropathy were significantly higher than those in the unchanged group (21%, 32%, and 42% vs. 3%, 6%, and 12%, respectively; P < 0.05), and the rate of splenectomy was significantly lower in the exacerbated group than in the unchanged group (5% vs. 39%, respectively; P < 0.01). In multivariate analysis, exacerbation of esophageal varices and absence of splenectomy were significantly associated with PHE exacerbation. The rate of gastrointestinal bleeding after follow-up CE was significantly high in the exacerbated group (log-rank, P = 0.037).
Exacerbation of esophageal varices and splenectomy were significantly associated with exacerbation of PHE. Exacerbated PHE requires specific attention to prevent gastrointestinal bleeding.
门脉高压性肠病（PHE）是门脉高压患者观察到的小肠病变。PHE 的内镜表现的临床意义尚不清楚。我们旨在根据长期结果阐明 PHE 胶囊内镜表现的临床意义和预测因素。
这项回顾性研究纳入了 55 例 PHE 患者（33 名男性和 22 名女性；中位年龄 64 岁；范围 23-87 岁），他们在 2009 年 2 月至 2023 年 5 月期间接受了胶囊内镜（CE）检查并随访了>3 年。我们通过比较 PHE 加重和未加重组，评估了影响 PHE 加重的临床因素以及 PHE 加重对胃肠道出血的影响。
总体而言，3 例（5%）患者病情改善，33 例（60%）病情保持不变，19 例（35%）在随访 CE 中病情加重。在加重组中，纤维化-4 指数恶化、食管静脉曲张加重和门脉高压性胃病加重的比例明显高于未加重组（21%、32%和 42% vs. 3%、6%和 12%；P<0.05），而脾切除术的比例在加重组明显低于未加重组（5% vs. 39%；P<0.01）。在多变量分析中，食管静脉曲张加重和无脾切除术与 PHE 加重显著相关。在随访 CE 后，出血的发生率在加重组中明显较高（对数秩检验，P=0.037）。
食管静脉曲张加重和脾切除术与 PHE 加重显著相关。加重的 PHE 需要特别注意，以防止胃肠道出血。
