Portal Hypertensive Enteropathy Before and After Variceal Obliteration: an Endoscopic, Histopathologic and Immunohistochemical Study

Abstract

Aim: To study portal hypertensive enteropathy (PHE) before and after the obliteration of esophageal varices.

Methods: 30 patients with portal hypertension and esophageal varices were included. Band ligation  was performed for every patient until the obliteration of esophageal varices. Enteroscopy and biopsies from gastric, duodenal and jejunal mucosa were taken at the beginning of the study and after variceal obliteration. Morphometric measurement of mean vascular areas and estimation of tissue vascular endothelial growth factor (VEGF) were also completed.

Results: The number of patients with enteropathy increased from 6.6% before obliteration to 46.7% after variceal obliteration (p< 0.001). Angiogenesis, vascular ectasia and blood extravasation were the main histopathological findings and all increased significantly after variceal obliteration. The mean vascular area of ectatic vessels in the gastric, duodenal and jejunal biopsies also increased after variceal obliteration. The mean VEGF in the gastric, duodenal and jejunal biopsies increased after variceal obliteration. The mean corpuscular volume (MCV) and hemoglobin (Hb) concentration were significantly lower after variceal obliteration.

Conclusion: the portal hypertensive enteropathic changes increased in frequency and severity after esophageal variceal obliteration with a probability of causing anemia.