Bresci G, Gambardella L, Parisi G, Federici G, Bertini M, Rindi G, Metrangolo S, Tumino E, Bertoni M, Cagno M C, Capria A
Unità Operativa Gastroenterologia, Azienda Ospedaliera Pisana, Ospedale Cisanello, Pisa, Italy.
J Clin Gastroenterol. 1998 Apr;26(3):222-7. doi: 10.1097/00004836-199804000-00016.
Fifty cirrhotic patients with portal hypertension but without colonic or systemic disease underwent lower gastrointestinal endoscopy in order to investigate the effects, if any, of portal hypertension on the colon. Fifty patients without liver or systemic disease, examined by colonoscopy because of irritable bowel syndrome in the same period served as controls. Rectosigmoid varices were observed in 34% of the cirrhotic patients and 2% of the controls. Hemorrhoids were observed in 70% of the cirrhotic patients and 48% of the controls. Multiple vascular-appearing lesions were found in 16% of the cirrhotic patients and 6% of the controls. Nonspecific inflammatory changes were noted in 10% of the cirrhotic patients and 4% of the controls. Simultaneous presence, in the same patient, of rectosigmoid varices, hemorrhoids, multiple vascular-appearing lesions, and nonspecific inflammatory changes, was observed in only five (10%) of the cirrhotic patients. We found polyps in 12% of the cirrhotic patients and 14% of the controls, and a malignant tumor in 4% of the cirrhotic patients. The patients with normal colonoscopic findings were 8% of the cirrhotic patients and 36% of the controls. All patients and controls were followed up for 1 year; there was no gastrointestinal hemorrhage among controls, whereas 34% of the cirrhotic patients had an upper gastrointestinal hemorrhage (88% from esophageal varices, 12% from the stomach) and 4% had a lower gastrointestinal hemorrhage (one from rectosigmoid varices and one from nonspecific inflammatory lesions). Colonic lesions were significantly more frequent in the cirrhotic patients (92%) than in the control group (64%); however, such lesions did not seem specific to the disease and were not statistically correlated with the degree of esophageal varices by Child's grading, the etiology of cirrhosis, or the bleeding risk from the lower gastrointestinal tract.
五十名患有门静脉高压但无结肠或全身性疾病的肝硬化患者接受了下消化道内镜检查，以研究门静脉高压对结肠的影响（若有影响的话）。同期因肠易激综合征接受结肠镜检查的五十名无肝脏或全身性疾病的患者作为对照。在34%的肝硬化患者和2%的对照者中观察到直肠乙状结肠静脉曲张。在70%的肝硬化患者和48%的对照者中观察到痔疮。在16%的肝硬化患者和6%的对照者中发现多处血管样病变。在10%的肝硬化患者和4%的对照者中注意到非特异性炎症改变。仅在五名（10%）肝硬化患者中观察到在同一患者身上同时存在直肠乙状结肠静脉曲张、痔疮、多处血管样病变和非特异性炎症改变。我们在12%的肝硬化患者和14%的对照者中发现息肉，在4%的肝硬化患者中发现恶性肿瘤。结肠镜检查结果正常的患者在肝硬化患者中占8%，在对照者中占36%。所有患者和对照者均随访1年；对照者中无胃肠道出血，而34%的肝硬化患者发生上消化道出血（88%来自食管静脉曲张，12%来自胃），4%发生下消化道出血（一例来自直肠乙状结肠静脉曲张，一例来自非特异性炎症病变）。肝硬化患者的结肠病变明显比对照组（64%）更常见（92%）；然而，此类病变似乎并非该疾病所特有，且与Child分级的食管静脉曲张程度、肝硬化病因或下消化道出血风险无统计学关联。
