Portal Hypertensive Colopathy

Portal hypertensive colopathy (PHC) is a condition in which changes occur in the mucosal membrane of colon in patients affected with portal hypertension and liver cirrhosis. PHC is the main cause of bleeding in lower gastro intestinal (GI) tract, erytherma in the mucosal membrane of colon, telangiectasias, vascular lesions, and angiodysplasia-like lesions.

Severity of PHC is dependent on the stage of the lesions. Early stage lesion is identified by slightly dilated, thin-walled, tortuous venules and veins lined by endothelial cells found in tela submucosa. Advance-stage lesions are more expanded submucosal veins, capillaries, and tortuous venules in the colonic mucous membrane or mucosa. Nevertheless, the occurrence of portal hypertensive colopathy and anorectal varices is very high in patients with portal hypertension.

Epidemiology

The term portal hypertensive colopathy was first described in 1991. It is mainly caused due to portal hypertension and liver cirrhosis.

In the case of patients with portal hypertension, PHC is the result of the constant accumulation of blood within portal venous system that leads to ectasia and dilation on the layer of tissue vessels in in the colonic mucosa. Portal hypertension is a condition in which the blood pressure in the portal veins increase due to the disturbance in blood flow through the liver. It results in changes in the colonic mucosal area, which is indicated by friability in tissues.

PHC is significantly related to cirrhotic patients with Child-Pugh class B and C. Complications of Child-Pugh class such as decrease in platelet count may result in bleeding of the lower GI tract. This decrease in platelet count increases the prevalence of PHC in cirrhotic patients.

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