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Prevalence, nature, and predictors of colonic changes in children with extrahepatic portal vein obstruction.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-07 , DOI: 10.1016/j.gie.2019.11.042 Nagendra Kumar 1 , Anshu Srivastava 1 , Niraj Kumari 2 , Somit Mittal 3 , Surender K Yachha 1 , Zafar Nayez 3 , Ujjal Poddar 1
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-07 , DOI: 10.1016/j.gie.2019.11.042 Nagendra Kumar 1 , Anshu Srivastava 1 , Niraj Kumari 2 , Somit Mittal 3 , Surender K Yachha 1 , Zafar Nayez 3 , Ujjal Poddar 1
Affiliation
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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.
中文翻译：
患肝外门静脉阻塞的患儿的结肠变化的患病率，性质和预测因素。
背景与目的有关肝外门静脉阻塞（EHPVO）患儿结肠改变的医学文献有限。我们评估了EHPVO儿童的患病率，性质以及结肠变化与疾病持续时间，脾门轴（SPA）血栓形成程度，门脉高压性胃病（PHG）和食管静脉曲张（EV）的关系。研究了组织学变化与内窥镜检查变化之间的相关性。方法通过结肠镜检查，回肠镜检查和活检采样，临床实验室概况以及SPA成像对受试者进行评估。结肠变化分为静脉曲张（直肠/结肠）和门脉高压性结肠病（PHC；结肠炎样或血管病变）。进行了结肠活检标本的形态分析。结果54名儿童（中位年龄12岁[范围8-15]；便血9名[16。6％]）进行了评估。直肠和结肠静脉曲张分别见于51例（94％）和2例（3.7％）。75％的患者患有PHC，结肠炎样病变比血管病变更常见（36/40 vs 23/40； P = .001）。结肠病变的发生率为52.5％，左侧为42.5％，右侧为5％。16％（8/49）的患者有回肠改变。患有PHC的儿童发生PHG的频率更高（90％比57％； P = .01），内窥镜检查的次数更多（平均6 [范围4-8] vs 2 [范围1-4]； P = .03），大型电动汽车比没有结肠病的电动汽车更少（12.5％比43％； P = .02）。有无PHC患者的SPA血栓形成程度相似。EHPVO中每个隐窝的毛细血管数量高于对照组。形态变化与内窥镜检查无相关性。结论大多数EHPVO儿童有结肠改变，而16％有回肠病。“结肠炎样”改变和左侧受累更为常见。PHG和电动车根除的患者发生PHC的风险更高。
更新日期：2019-12-07
中文翻译：
患肝外门静脉阻塞的患儿的结肠变化的患病率，性质和预测因素。
背景与目的有关肝外门静脉阻塞（EHPVO）患儿结肠改变的医学文献有限。我们评估了EHPVO儿童的患病率，性质以及结肠变化与疾病持续时间，脾门轴（SPA）血栓形成程度，门脉高压性胃病（PHG）和食管静脉曲张（EV）的关系。研究了组织学变化与内窥镜检查变化之间的相关性。方法通过结肠镜检查，回肠镜检查和活检采样，临床实验室概况以及SPA成像对受试者进行评估。结肠变化分为静脉曲张（直肠/结肠）和门脉高压性结肠病（PHC；结肠炎样或血管病变）。进行了结肠活检标本的形态分析。结果54名儿童（中位年龄12岁[范围8-15]；便血9名[16。6％]）进行了评估。直肠和结肠静脉曲张分别见于51例（94％）和2例（3.7％）。75％的患者患有PHC，结肠炎样病变比血管病变更常见（36/40 vs 23/40； P = .001）。结肠病变的发生率为52.5％，左侧为42.5％，右侧为5％。16％（8/49）的患者有回肠改变。患有PHC的儿童发生PHG的频率更高（90％比57％； P = .01），内窥镜检查的次数更多（平均6 [范围4-8] vs 2 [范围1-4]； P = .03），大型电动汽车比没有结肠病的电动汽车更少（12.5％比43％； P = .02）。有无PHC患者的SPA血栓形成程度相似。EHPVO中每个隐窝的毛细血管数量高于对照组。形态变化与内窥镜检查无相关性。结论大多数EHPVO儿童有结肠改变，而16％有回肠病。“结肠炎样”改变和左侧受累更为常见。PHG和电动车根除的患者发生PHC的风险更高。
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