Advertisement

Prevalence, nature, and predictors of colonic changes in children with extrahepatic portal vein obstruction

Published:December 06, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.042

      Background and Aims

      The medical literature on colonic changes in children with extrahepatic portal venous obstruction (EHPVO) is limited. We evaluated EHPVO children for prevalence, nature, and relation of colonic changes with disease duration, extent of splenoportal axis (SPA) thrombosis, portal hypertensive gastropathy (PHG), and esophageal varices (EVs). The correlation between histologic and endoscopic changes was studied.

      Methods

      Subjects were evaluated by colonoscopy with ileoscopy and biopsy sampling, clinico-laboratory profiles, and SPA imaging. Colonic changes were classified as varices (rectal/colonic) and portal hypertensive colopathy (PHC; colitis-like or vascular lesions). Morphometric analysis of colonic biopsy specimens was performed.

      Results

      Fifty-four children (median age, 12 years [range, 8-15]; hematochezia in 9 [16.6%]) were evaluated. Rectal and colonic varices were seen in 51 (94%) and 2 (3.7%) cases, respectively. Seventy-five percent of patients had PHC, and colitis-like lesions were more common than vascular lesions (36/40 vs 23/40; P = .001). Colopathy changes were pancolonic in 52.5%, left-sided in 42.5%, and right-sided in 5% of cases. Sixteen percent of patients (8/49) had ileal changes. Children with PHC had PHG more often (90% vs 57%; P = .01), more endotherapy sessions (mean 6 [range, 4-8] vs 2 [range, 1-4]; P = .03), and large EVs less often (12.5% vs 43%; P = .02) than those without colopathy. The extent of SPA thrombosis was similar in patients with and without PHC. The number of capillaries per crypt was higher in EHPVO than in control subjects. Morphometric changes had no correlation with endoscopy.

      Conclusions

      Most EHPVO children had colonic changes, and 16% had ileopathy. “Colitis-like” changes and left-side involvement were more common. Patients with PHG and eradicated EVs had a higher risk of PHC.

      Graphical abstract

      Abbreviations:

      EHPVO (extrahepatic portal vein obstruction), EST (endoscopic sclerotherapy), EV (esophageal varix), EVL (endoscopic variceal ligation), IMV (inferior mesenteric vein), PHC (portal hypertensive colopathy), PHG (portal hypertensive gastropathy), PHT (portal hypertension), PV (portal vein), RV (rectal varix), SMV (superior mesenteric vein), SPA (splenoportal axis), SV (splenic vein)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yachha S.K.
        • Khanduri A.
        • Sharma B.C.
        • et al.
        Gastrointestinal bleeding in children.
        J Gastroenterol Hepatol. 1996; 11: 903-907
        • Poddar U.
        • Thapa B.R.
        • Rao K.N.
        • et al.
        Etiological spectrum of esophageal varices due to portal hypertension in Indian children: Is it different from the West?.
        J Gastroenterol Hepatol. 2008; 23: 1354-1357
        • Arora N.K.
        • Lodha R.
        • Gulati S.
        • et al.
        Portal hypertension in North Indian children.
        Indian J Pediatr. 1998; 65: 585-591
        • Poddar U.
        • Thapa B.R.
        • Singh K.
        Frequency of gastropathy and gastric varices in children with extrahepatic portal venous obstruction treated with sclerotherapy.
        J Gastroenterol Hepatol. 2004; 19: 1253-1256
        • Zargar S.A.
        • Javid G.
        • Khan B.A.
        • et al.
        Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction.
        Hepatology. 2002; 36: 666-672
        • Misra S.P.
        • Dwivedi M.
        • Misra V.
        • et al.
        Colonic changes in patients with extra hepatic portal vein obstrcution.
        Endoscopy. 2005; 37: 454-459
        • Chawla Y.
        • Dilawari J.B.
        Anorectal varices—their frequency in cirrhotic and noncirrhotic portal hypertension.
        Gut. 1991; 32: 309-311
        • Ganguly S.
        • Sarin S.K.
        • Bhatia V.
        • et al.
        The prevalence and spectrum of colonic lesions in patients with cirrhotic and noncirrhotic portal hypertension.
        Hepatology. 1995; 21: 1226-1231
        • Goenka M.K.
        • Kochhar R.
        • Nagi B.
        • et al.
        Rectosigmoid varices and other mucosal changes in patients with portal hypertension.
        Am J Gastroenterol. 1991; 86: 1185-1189
        • Heaton N.D.
        • Davanport M.
        • Howard E.R.
        Incidence of haemorrhoids and anorectal varices in children with portal hypertension.
        Br J Surg. 1993; 80: 616-618
        • Yachha S.K.
        • Dhiman R.K.
        • Gupta R.
        • et al.
        Endosonographic evaluation of the rectum in children with extrahepatic portal venous obstruction.
        J Pediatr Gastroenterol Nutr. 1996; 23: 438-441
        • Sarin S.K.
        • Sollano J.D.
        • Chawla Y.K.
        • et al.
        Consensus on extra-hepatic portal vein obstruction.
        Liver Int. 2006; 26: 512-519
        • Poddar U.
        • Shava U.
        • Yachha S.K.
        • et al.
        β-Blocker therapy ameliorates hypersplenism due to portal hypertension in children.
        Hepatol Int. 2015; 9: 447-453
        • Conn H.O.
        Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiological and biochemical techniques.
        J Lab Clin Med. 1967; 70: 442-451
        • McCormack T.T.
        • Sims J.
        • Eyre-Brook I.
        • et al.
        Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?.
        Gut. 1985; 26: 1226-1232
        • Sarin S.K.
        • Gupta N.
        • Jha S.K.
        • et al.
        Equal efficacy of endoscopic variceal ligation and propronalol in preventing variceal bleeding in patients with noncirrhotic portal hypertension.
        Gastroenterology. 2010; 139: 1238-1245
        • Pall H.
        • Zacur G.M.
        • Kramer R.E.
        • et al.
        Bowel preparation for pediatric colonoscopy: Report of the NASPGHAN Endoscopy and Procedures Committee..
        J Pediatr Gastroenterol Nutr. 2014; 59: 409-416
        • Bini E.J.
        • Lascarides C.E.
        • Micale P.L.
        • et al.
        Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study.
        Gastrointest Endosc. 2000; 52: 511-516
        • Urrunaga N.H.
        • Rockey D.C.
        Portal hypertensive gastropathy and colopathy.
        Clin Liver Dis. 2014; 18: 389-406
        • Yamakado S.
        • Kanazawa H.
        • Kobayashi M.
        Portal hypertensive colopathy: endoscopic findings and the relation to portal pressure.
        Intern Med. 1995; 34: 153-157
        • Maratka Z.
        Endoscopic diagnosis and terminology of erosions and similar mucosal lesions.
        Gastrointest Endosc. 1996; 43: 633-636
        • Borkar V.V.
        • Poddar U.
        • Kumari N.
        • et al.
        Duodenal morphometry and small bowel permeability in children with portal hypertension.
        J Pediatr Gastroenterol Nutr. 2015; 60: 171-176
        • Rana S.S.
        • Bhasin D.K.
        • Jahagirdar S.
        • et al.
        Is there ileopathy in portal hypertension?.
        J Gastroenterol Hepatol. 2006; 21: 392-397
        • Dilawari J.B.
        • Chawla Y.K.
        Spontaneous (natural) splenoadrenorenal shunts in extrahepatic portal venous obstruction: a series of 20 cases.
        Gut. 1987; 28: 1198-1200
        • Lamps L.W.
        • Hunt C.M.
        • Green A.
        • et al.
        Alterations in colonic mucosal vessels in patients with cirrhosis and noncirrhotic portal hypertension.
        Hum Pathol. 1998; 29: 527-535
        • Ozgediz D.
        • Devine P.
        • Garcia-Aguilar J.
        • et al.
        Refractory lower gastrointestinal bleeding from portal hypertensive colopathy.
        J Am Coll Surg. 2008; 207: 613
        • Higaki N.
        • Matsui H.
        • Imaoka H.
        • et al.
        Characteristic endoscopic features of portal hypertensive enteropathy.
        J Gastroenterol. 2008; 43: 327-331
        • Varanasi R.V.
        • Fleisher A.S.
        • Darwin P.E.
        • et al.
        Colonoscopic sclerotherapy of ileal varices.
        Gastrointest Endosc. 2000; 52: 109-111
        • Herman B.E.
        • Baum S.
        • Denobile J.
        • et al.
        Massive bleeding from rectal varices.
        Am J Gastroenterol. 1993; 88: 939-942
        • McCormack T.T.
        • Bailey H.R.
        • Simms J.M.
        • et al.
        Rectal varices are not piles.
        Br J Surg. 1984; 71: 163
        • Shudo R.
        • Yazaki Y.
        • Sakurai S.
        • et al.
        Clinical study comparing bleeding and nonbleeding rectal varices.
        Endoscopy. 2002; 34: 189-194
        • Sarin S.K.
        • Sreenivas D.V.
        • Lahoti D.
        • et al.
        Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension.
        Gastroenterology. 1992; 102: 994-999
        • Rabinovitz M.
        • Schade R.R.
        • Dindzans V.J.
        • et al.
        Colonic disease in cirrhosis. An endoscopic evaluation in 412 patients.
        Gastroenterology. 1990; 99: 195-199
        • Eleftheriadis E.
        • Kotazampassi K.
        • Karakavelas G.
        • et al.
        Portal hypertensive colopathy: endoscopic, hemodynamic and morphometric study.
        Dig Endosc. 1993; 5: 224-230
        • Itha S.
        • Yachha S.K.
        Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction.
        J Pediatr Gastroenterol Nutr. 2006; 42: 196-200
        • Gonçalves M.E.P.
        • Cardoso S.R.
        • Maksoud J.G.
        Prophylactic sclerotherapy in children with esophageal varices: long-term results of a controlled prospective randomized trial.
        J Pediatr Surg. 2000; 35: 401-405
        • Iwao T.
        • Toyonaga A.
        • Sumino M.
        • et al.
        Portal hypertensive gastropathy in patients with cirrhosis.
        Gastroenterology. 1992; 102: 2060-2065
        • Misra V.
        • Misra S.P.
        • Dwivedi M.
        • et al.
        Colonic mucosa in patients with portal hypertension.
        J Gastroenterol Hepatol. 2003; 18: 302-308
        • Guimarães R.A.
        • Perazzo H.
        • Machado L.
        • et al.
        Prevalence, variability, and outcomes in portal hypertensive colopathy: a study in patients with cirrhosis and paired controls.
        Gastrointest Endosc. 2015; 82: 469-476
        • Sen Sarma M.
        • Yachha S.K.
        • Rai P.
        • et al.
        Cholangiopathy in children with extrahepatic portal venous obstruction.
        J Hepatobil Pancreat Sci. 2018; 25: 440-447
        • Shneider B.L.
        • de Ville de Goyet J.
        • Leung D.H.
        • et al.
        Primary prophylaxis of variceal bleeding in children and the role of MesoRex bypass: summary of the Baveno VI Pediatric Satellite Symposium.
        Hepatology. 2016; 63: 1368-1380