An endoscopic study for portal hypertensive colopathy and lower gastrointestinal bleeding in cirrhotic egyptian patients with history of hematemesis

Background: Liver cirrhosis is one of the most common health problems. It complicated by gastro esophageal varices, portal hypertension, portal hypertensive gastropathy and colopathy. However, the incidence and association of hypertensive colopathy with other complications of liver cirrhosis was not well addressed. Aim of the work: to endoscopic ally address portal hypertensive colopathy and other cirrhotic complications in cirrhotic Egyptian patients with or without hematemesis. Methodology: This study was carried out on sixty cirrhotic patients with portal hypertension. They were selected from Al-Azhar university hospital (New Damietta) and Egyptian Liver Research Institute (Sherbin). The studied patients; were divided into two major groups: Group I included thirty cirrhotic patients with portal hypertension with history of hematemesis and lower gastro intestinal bleeding (hematochezia). Group II included thirty cirrhotic patients with no history of hematemesis. All patients were submitted to full history taking, clinical & ultrasound examination and upper GIT endoscopy. Finally, colposcopy was performed to estimate portal hypertensive colopathy and other lower GIT abnormalities. Results: there was non-significant difference between groups 1 and 2 as regard to age, sex and portal vein diameter. While, there was significant increase of hematemesis, melena, jaundice and severity of liver cirrhosis, ascites, splenic size, and collateral in group 1 when compared to group 2, while there was significant decrease of PV velocity in group 1 when compared to group 1. Also, there was significant decrease of hemoglobin, hematocrit, platelets and albumin in group 1 when compared to group 2. On the other hand, there was significant increase of ALT, alkaline phosphatase, ESR and creatinine in group 1 when compared to group 2. In addition, there was significant increase of sclerotherapy, band ligation, esophageal varices grade, number of gastric varices, severity of PHG, rectal varices, vascular ectasia, erythema, and PHC degree in group 1 when compared to group 2. Finally, cases with higher grades of PHC had increased number of hematemesis, melena, sclerotherapy, severity of liver disease, higher number of lower GIT bleeding, increased collaterals, higher grade of esophageal varices, gastric varices, PHG, higher splenic size, increased portal vein diameter, decreased portal vein velocity, decreased platelets and higher INR. Conclusion: patients with liver cirrhosis either with or without past history of hematemesis had a higher incidence of PHC and these PHC was associated with severity of liver cirrhosis, esophageal varices, and lower gastro-intestinal bleeding.