Portal hypertensive enteropathy
摘要
Portal hypertensive enteropathy （PHE） is a conditionthat describes the pathologic changes and mucosalabnormalities observed in the small intestine of patientswith portal hypertension. This entity is being increasinglyrecognized and better understood over the past decadedue to increased accessibility of the small intestine madepossible by the introduction of video capsule endoscopyand deep enteroscopy. Though challenged by its diverseendoscopic appearance, multiple scoring systems havebeen proposed to classify the endoscopic presentationand grade its severity. Endoscopic findings can be broadlycategorized into vascular and non-vascular lesions withmany subtypes of both categories. Clinical manifestationsof PHE can range from asymptomatic incidental findingsto fatal gastrointestinal hemorrhage. Classic endoscopicfindings in the setting of portal hypertension may leadto a prompt diagnosis. Occasionally histopathologyand cross sectional imaging like computed tomographyor magnetic resonance imaging may be helpful inestablishing a diagnosis. Management of overt bleedingrequires multidisciplinary approach involving hepatologists,endoscopists, surgeons, and interventionalradiologists. Adequate resuscitation, reduction of portalpressure, and endoscopic therapeutic intervention remainthe main principles of the initial treatment. This articlereviews the existing evidence on PHE with emphasison its classification, diagnosis, clinical manifestations,endoscopic appearance, pathological findings, and clinicalmanagement. A new schematic management of ectopicvariceal bleed is also proposed.