Tam T N, NG W W, Lee S D
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Gastrointest Endosc. 1995 Nov;42(5):408-12. doi: 10.1016/s0016-5107(95)70040-4.
Portal colopathy has been reported in patients with cirrhosis of the liver. The aim of this study is to evaluate colonic mucosal changes and their clinical significance.
Seventy-five cirrhotic patients with anemia and hemoccult-positive stool and 75 control subjects underwent endoscopic examinations of lower gastrointestinal tract.
Colonic ectasiae were found to be significantly more common in the 75 cirrhotic patients (80% with hepatitis B or C infection) than control subjects (84% vs 0, p < 0.0001). The lesions in 63 cirrhotic patients were found throughout the entire colon. They included colonic telangiectasiae or angiodysplastic-like lesions in 56 (89%) patients, red spots in 14 (22%), features suggesting mild chronic colitis in 8 (13%), and midrectal colorectal varices in 10 (16%). Pathologic findings in patients with telangiectasiae or angiodysplastic-like lesions showed dilation of vessels (7 of 9 patients) and edema of mucosa (6 of 9 patients). There was no correlation between the severity of cirrhosis, grade of esophageal varices, and the presence of colonic ectasiae.
Our observations demonstrate that colonic mucosal changes commonly occur in cirrhotic patients with viral hepatitis. The risk of intermittent hemorrhage from colonic ectasiae should be considered in cirrhotic patients with anemia but without evidence of upper gastrointestinal bleeding. These characteristic lesions may represent a spectrum of portal in hypertensive intestinal vasculopathy.
已有报道称肝硬化患者会出现门静脉性结肠病。本研究旨在评估结肠黏膜变化及其临床意义。
75例患有贫血且大便潜血阳性的肝硬化患者和75例对照受试者接受了下消化道内镜检查。
发现75例肝硬化患者（80%为乙型或丙型肝炎感染）中结肠扩张明显比对照受试者更常见（84% 对0，p < 0.0001）。在63例肝硬化患者中发现病变遍布整个结肠。其中包括56例（89%）患者出现结肠毛细血管扩张或血管发育异常样病变、14例（22%）患者出现红点、8例（13%）患者有提示轻度慢性结肠炎的特征以及10例（16%）患者出现直肠中下段大肠静脉曲张。毛细血管扩张或血管发育异常样病变患者的病理结果显示血管扩张（9例患者中的7例）和黏膜水肿（9例患者中的6例）。肝硬化严重程度、食管静脉曲张分级与结肠扩张的存在之间无相关性。
我们的观察结果表明，病毒性肝炎肝硬化患者常出现结肠黏膜变化。对于患有贫血但无证据表明存在上消化道出血的肝硬化患者，应考虑结肠扩张间歇性出血的风险。这些特征性病变可能代表门静脉高压性肠血管病 spectrum of portal in hypertensive intestinal vasculopathy（此处原文表述似乎有误，推测可能是“a spectrum of portal hypertensive intestinal vasculopathy”，即一系列门静脉高压性肠血管病）的一种表现形式。
