结肠癌筛检的新方法:转铁蛋白试验与免疫粪隐血试验的对照研究

目的分析转铁蛋白试验(Tf)检测结肠癌及癌前病变的效率,并与免疫粪隐血试验(IFOBT)对比。方法收集接受结肠镜检查的110例患者的粪便标本,包括40例结肠癌,36例癌前病变(16例高危腺瘤、20例溃疡性结肠炎),34例低危病变,分别进行IFOBT、Tf和两者联合检测(IFOBT+Tf)。结果对于结肠癌和癌前病变,转铁蛋白检测的阳性率(76%)明显高于免疫粪隐血试验(61%)(2χ=4.38;P0.05);尤其在癌前病变的检测中,两种试验阳性率的差异更为显著(Tf:72%,IFOBT:44%;2χ=5.71;P0.05);而在低危组,两者的阳性率无显著差异(P0.05)。转铁蛋白试验和免疫粪隐血试验联合检测,肿瘤检测的阳性率可达90%,癌前病变为78%,低危组为29%。Tf和IFOBT检测结肠癌和癌前病变的准确率分别为69.0%和76.4%。结论转铁蛋白试验敏感性高,可用于检测肿瘤及癌前病变,为结肠癌的筛检提供了新的途径。     

免疫法和化学法粪便隐血试验在上消化道出血性疾病中阳性率的比较

目的:比较免疫法粪便隐血试验(immune fecal occult blood test,IFOBT)和化学法粪便隐血试验(chemical fecal occult blood test.CFOBT)在上消化道出血性疾病中的阳性率,以验证IFOBT筛查上消化道出血不具特异性.方法:2006-07/2007-03间连续选择我院内镜中心进行胃镜检查的上消化道出血性疾病患者206例,利用邻甲苯胺CFOBT和IFOBT同时比较两种粪便隐血试验的阳性率,并结合临床资料分析其相应结果.结果:IFOBT和CFOBT结果均与食管癌、胃癌的解剖部位及食管癌浸润深度无关,两者均与胃癌浸润深度有关,与胃癌的最大长径呈正相关(IFOBT:r=0.30,P=0.02;CFOBT:r=0.20,P=0.04);IFOBT与食管癌的最大长径呈正相关(r=0.38,P=0.01);CFOBT在食管癌患者中的阳性率高于食管磷状细胞癌抗原(SCC)的阳性率(47.43% vs 20.45%,P＜0.05);两者在胃癌患者中的阳性率均高于CA125,CEA和CA199的阳性率.CFOBT检测胃癌、食管癌、返流性食管炎和消化性溃疡的阳性率均高于IFOBT(50.88% vs 35.09%,47.73% vs 29.55%,18.00% vs 6.00%,60.00% vs 41.82%,均P＜0.05).IFOBT在上消化道出血性疾病中的总阳性率低于CFOBT.结论:IFOBT粪便隐血试验不适合上消化道出血性疾病的筛查,可能对下消化道出血性疾病的筛查具有相对特异性.     

粪便DNA中MGMT、XAF1基因启动子甲基化联合检测在结直肠癌筛查中的应用研究

目的使用甲基化特异性PCR(MSP)方法检测粪便DNA中O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)、X染色体连锁凋亡抑制蛋白相关因子1(XAF1)基因启动子甲基化情况,并探讨其在结直肠肿瘤诊断中的意义。方法收集40例结直肠腺癌、40例腺瘤性息肉、52例正常对照住院患者粪便标本,使用试剂盒提取其粪便中肠道脱离细胞DNA,通过MSP方法检测其MGMT、XAF1基因启动子甲基化情况。结果 MGMT、XAF1基因启动子甲基化在结直肠腺癌中的阳性率分别为50.0%、55.9%;在腺瘤性息肉中的阳性率分别为42.1%、52.6%;二者联合检测在结直肠腺癌及腺瘤性息肉中的阳性率分别为73.5%、68.4%;特异性为52.0%。结直肠腺癌患者粪便中粪便潜血阳性率为35.3%,CEA阳性率为35.3%。结论通过试剂盒提取粪便DNA具有较高成功率;粪便DNA中MGMT、XAF1基因启动子甲基化状态用于检测结直肠腺癌及腺瘤性息肉具有较高的敏感性。检测粪便基因甲基化有望成为CRC高风险人群筛查的一个重要途径。     

粪便转铁蛋白试验在提高消化道出血检出率中的作用

目的研究粪便转铁蛋白试验（TFPT）与免疫粪隐血试验（IFOBT）互补的可行性,以提高消化道出血的检出率。方法连续性收集接受胃镜或结肠镜检查患者的粪便,其中上消化道出血性疾病27例,上消化道非出血性疾病31例;下消化道出血性疾病30例,下消化道非出血性疾病16例。分别计算IFOBT和TFPT的敏感性、特异性、阳性预示值、阴性预示值,再计算转铁蛋白试验与粪隐血试验的互补率。结果在上消化道出血性疾病中,TFPT的敏感性（8/27）显著高于IFOBT（2/27）（P〈0.05）。在下消化道出血性疾病中,TFPT的敏感性（25/30）也显著高于IFOBT（16/30）（P〈0.05）。两个试验结合互补后,将上、下消化道出血检出率分别提高到29.6%和83.3%。结论无论是上消化道出血还是下消化道出血,转铁蛋白试验的敏感性均高于免疫粪隐血试验。两个试验结合互补可明显提高消化道出血的检出效率。     

纳米叶酸磁珠靶向检测技术在老年结直肠癌患者早期诊断中的应用

目的探讨纳米叶酸磁珠靶向检测技术在老年结直肠癌患者早期诊断中的应用。方法经肠镜活检确诊的早期结直肠癌老年患者115例,随机分为两组,即A组-新型清肠液收集装置检测,63例;B组-新型清肠液收集装置结合纳米叶酸磁珠检测,52例。收集患者自然粪便和结肠镜检前的清肠液;转铁蛋白检测法检测粪便中的转铁蛋白;应用常规方法和纳米叶酸磁珠检验粪便脱落细胞筛查早期结直肠癌。结果 A、B两组自然粪便中便隐血试验阳性人数均较清肠液低(P均0.05);A、B两组自然粪便中通过检验粪便脱落细胞筛查早期结直肠癌的阳性人数较清肠液低(P均0.05);使用纳米叶酸磁珠靶向检测技术的阳性率在两组中都比使用传统检测技术高(P均0.05)。结论纳米叶酸磁珠靶向检测技术在老年结直肠癌患者早期诊断中的应用效果非常显著,可能是对结直肠癌进行早期筛查和诊断的良好方法。     

人乳头瘤病毒快速检测分型方法的临床应用

目的探讨人乳头瘤病毒(HPV)免疫层析技术快速检测分型方法的临床应用价值。方法采用免疫层析技术快速检测法对人乳头瘤病毒进行检测分型,采用基因检测技术PCR检测法作对照。结果对386例标本进行HPV常见亚型6、11型和16、18型检测,快速检测法与对照PCR检测法均105例阳性,阳性率均为27.20%,两种方法的阳性率一致(P>0.05)。对HPV亚型总的分型检测,快速检测法检出阳性105例,阳性率为27.20%;对照PCR检测法检出HPV阳性142例,阳性率为36.78%,两种方法的阳性率差异有统计学意义(χ2=8.15,P<0.05)。结论免疫层析快速检测分型方法用于HPV常见亚型6、11型(低危型)和16、18型(高危型)检测,具有操作简便,检测速度快,准确率高,医疗成本较低等特点,值得基层医院推广应用。     

非霍奇金淋巴瘤患者外周血及骨髓中免疫球蛋白、T 细胞受体基因重排检测的意义

目的探讨非霍奇金淋巴瘤(NHL)患者骨髓及外周血中免疫球蛋白(Ig)、T细胞受体(TCR)基因单克隆重排检测的临床意义。方法以BIOMED-2引物系统及多重PCR方法对60例NHL患者骨髓或外周血标本进行Ig及TCR基因重排检测。结果 B细胞NHL中,39.02%检出Ig基因单克隆重排,T细胞NHL中36.84%检出TCR基因单克隆重排;14例早期与46例晚期患者的Ig和(或)TCR基因单克隆重排阳性率分别为28.57%和41.3%;11例低变恶性患者和49例中、高度恶性患者的Ig和(或)TCR基因单克隆重排阳性率分别为36.36%和38.78%;以上两者间比较差异均无统计学意义(P均>0.05)。53例NHL患者骨髓涂片检测骨髓侵犯阳性率为13.21%,明显低于骨髓基因重排检测阳性率(43.40%),两者比较差异有统计学意义(P<0.05)。结论骨髓及外周血Ig及TCR基因重排PCR检测有助于早期发现骨髓侵犯及MRD。     

208例上消化道出血患者的病因分析及胃镜诊断体会

目的对208例上消化道出血患者的病因进行分析,探讨胃镜的诊断价值。方法回顾性分析我院2010年6月-2012年6月收治的208例上消化道出血患者胃镜诊断结果。结果消化性溃疡是不同年龄组上消化道出血的主要病因,中青年组消化性溃疡出血比率(42.4%)高于老年组(27.7%,P<0.05)。消化道肿瘤在老年组上消化道出血中所占的比例为23.7%,明显高于中青年组的7.6%(P<0.01),是老年人上消化道出血的常见原因。急诊胃镜组病因检出率为97.5%,高于非急诊胃镜组的87.5%(P<0.05)。结论上消化道出血的病因较多,以消化性溃疡最为常见。胃镜对上消化道出血病因诊断有较高价值,可作为首选方法。     

艾滋病与肝病患者胃窦黏膜活检快速尿素酶检测幽门螺杆菌与病理学染色的比较研究

目的探讨胃窦黏膜活检快速尿素酶试验(RUT)和病理学法检测幽门螺杆菌(Helicobacter pylori,H.pylori)的阳性率及其在艾滋病(AIDS)、慢性肝病和普通慢性胃病患者中的差异。方法选取937例因上腹部不适接受胃镜检查的患者,其中艾滋病组患者61例(艾滋病组),慢性肝病组患者600例(慢性肝病组),非艾滋病非肝病普通慢性胃病组患者276例(普通慢性胃病组)。所有患者均于胃镜检查中胃窦部取活检组织2块,分别进行RUT和病理学检测法检测H.pylori。结果胃窦黏膜活检RUT H.pylori的总体阳性率为47.0%,病理学染色检测法的总体阳性率为35.3%;艾滋病组和普通慢性胃病组病理学检测H.pylori阳性率(45.9%、57.97%)均高于同组RUT检验H.pylori阳性率(37.7%、38.77%,P0.05);慢性肝病组RUT检测H.pylori阳性率(42.83%)高于病理学检测H.pylori阳性率(32.67%)(P0.05);以病理学检测结果为最终诊断,慢性肝病组患者H.pylori感染率小于艾滋病组和普通慢性胃病组(P0.05),艾滋病组患者H.pylori感染率小于普通慢性胃病组,但差异无统计学意义(P0.05)。结论艾滋病、慢性肝病和普通慢性胃病患者胃窦黏膜活检RUT与病理学法检测H.pylori均有显著性差异,临床最终诊断结果仍应以病理学检测结果为准;慢性肝病患者RUT检测H.pylori存在较高假阳性及其H.pylori感染率低于艾滋病患者和普通慢性胃病患者。     

粪便钙卫蛋白检测诊断结直肠癌87例

目的:比较粪便钙卫蛋白、便潜血试验及血清CEA在结直肠癌诊断中的应用价值.方法:研究组共纳入肠镜证实的87例结直肠癌初诊患者,对照组60例接受肠镜检查的健康成人.所有研究对象在接受肠镜检查时留取大便标本,检测便潜血及粪便钙卫蛋白,肠镜检查后抽取静脉血4 mL,用于检测血清CEA.随访患者手术记录及手术病理.结果:粪便钙卫蛋白、便潜血试验及血清CEA诊断结直肠癌的敏感性分别为88.51%、83.91%和44.83%,特异性分别为88.33%、96.67%和93.33%.Dukes分期为A和B期患者便潜血试验及血清CEA的阳性率明显低于C和D期患者(P=0.0173,0.0059),Dukes不同分期的患者中,粪便钙卫蛋白的阳性率无明显差异:不同部位的结直肠癌与粪便钙卫蛋白、大便潜血试验及血清CEA的阳性率无显著差异:钙卫蛋白联合应用FOBT或/和CEA检测结直肠癌可以一定限度地提高其敏感性,但三种联合检测组合较单用粪便钙卫蛋白检测均无显著性差异.结论:粪便钙卫蛋白检测结直肠癌有较高的敏感性,且不受肿瘤分期的影响,可以作为门诊筛查结直肠癌的标志物.     

Accuracy of detection of colorectal neoplasia using an immunochemical occult blood test in symptomatic referred patients: comparison of retrospective and prospective studies

OBJECTIVE: In this study the sensitivity and specificity of immunochemical tests for colorectal neoplasia were evaluated in retrospective and prospective studies. METHODS: Four types of fecal blood tests--a chemical test (Hemoccult II) and three different immunochemical tests including a test which detects hemoglobin and transferrin- were performed in the retrospective study. In the prospective study the test for hemoglobin and transferrin was used for all patients that underwent total colonoscopy. PATIENTS: One hundred seven patients with colorectal neoplasia, 57 with gastroduodenal bleeding, and 62 with normal digestive tracts were examined retrospectively. One thousand two hundred and ninety-eight nonspecifically symptomatic patients whose endoscopic examination was negative for hemorrhagic lesions in the upper digestive tract were examined prospectively. RESULTS: In the retrospective study, sensitivities for the detection of colorectal cancers and adenomas with diameters > or =10 mm using the tests which detect hemoglobin and transferrin were 98% and 89%, respectively. These were the highest sensitivity among the four tests. The specificity of this test was 97%, which was higher than that of the Hemoccult II test. In the prospective study, the sensitivities of the tests for hemoglobin and transferrin for the detection of colorectal cancers and adenomas with diameters > or =10 mm were 79% and 33%, respectively. The specificity was 95%. CONCLUSIONS: The test for hemoglobin and transferrin showed the highest sensitivity and specificity for colorectal neoplasia in the retrospective study. The sensitivity and specificity of this test were not so high in the prospective study, but they may be clinically applicable in the evaluation of patients with various nonspecific symptoms.     

A comparative study of three fecal occult blood tests in upper gastrointestinal bleeding

The purpose of this study was to evaluate the performance characteristics of three fecal occult blood tests (FOBTs): the chemical o-toluidine test, the immunochemical OC-Hemodia test, and the immunochromatographic Quick Chaser Occult Blood (QCOB) test, which detect human hemoglobin and transferrin simultaneously in cases of upper gastrointestinal (GI) bleeding. Included were 48 FOBT specimens in 48 consecutive admission cases of upper GI bleeding (endoscopy confirmed). We excluded those fecal specimens with an obvious tarry and bloody appearance. The QCOB test revealed the highest positive rates of 33/48 (68.8%), and significantly higher positive rates than that of the OC-Hemodia test and o-toluidine test (p < 0.025 and < 0.01, respectively). In the patient group with upper GI bleeding due to gastric and duodenal ulcers, the QCOB test had higher positive rates (68.6%) than did the o-toluidine test (34.3%) (p < 0.01). There was no fecal specimen that was positive for the o-toluidine test or OC-Hemodia test and was negative for the QCOB test. Our results reveal that the QCOB test has significantly higher positive rates of fecal occult blood than either the OC-Hemodia test or o-toluidine test. The QCOB test is better than the other two tests for detecting occult blood in patients with upper GI bleeding.     

Immunological Determination of Fecal Hemoglobin and Transferrin Levels: A Comparison with Other Fecal Occult Blood Tests

Immunological determination of fecal hemoglobin and transferrin levels was performed in inpatients on an unrestricted diet, including patients with colon cancer or polyps and a control group. When hemoglobin levels of 5.1 micrograms/g feces and transferrin levels of 0.4 microgram/g feces were designated as positive, 48 of the 60 fecal specimens from colon cancer patients were positive. This result was significantly superior to that for another fecal occult blood immunological test (FECA-EIA) (p less than 0.005), and similar to the results of two chemical tests (guaiac and Hemoccult). Twenty-eight of the 78 fecal specimens from patients with colonic polyps were positive, again a result superior to the FECA-EIA (p less than 0.005) and similar to the chemical tests. Three of the 99 control fecal specimens were positive, which was a similar result to that obtained with the FECA-EIA and significantly superior to the chemical tests (both p less than 0.005). Thus, combined detection of fecal hemoglobin and transferrin levels can be used as a fecal occult blood test in patients without dietary restriction.     

Immunochemical Fecal Occult Blood Test Is Inadequate for Screening Test of Stomach Cancer

The present study was carried out to investigate the diagnostic accuracy of the immunochemical fecal occult blood test in the screening for stomach cancer. In the hospital-based case–control study, the test was positive in 6 (14.3%) subjects with stomach cancer, in 32 (76.2%) subjects with colorectal cancer, and in 10 (7.9%) healthy subjects, respectively, showing a significant difference in detection rate between the subjects with stomach cancer and colorectal cancer (p < 0.01). In the population-based cross-sectional study, detection rate for stomach cancer was 0.13% and 0.15% for negative and positive groups decided by immunochemical fecal occult blood test, indicating no significant difference. These results reveal that the immunochemical fecal occult blood test is inadequate as the screening test for stomach cancer and suggest that examination of the upper digestive tract is unnecessary in cases where the result of fecal occult blood test is positive with no sign of colorectal diseases.     

Iron-deficiency anemia due to chronic gastrointestinal bleeding.

AIMS: chronic gastrointestinal bleeding is the most common cause of iron deficiency anemia (IDA) in the general population. The objectives of this study were to determine the most frequent gastrointestinal lesions in IDA, the frequency and localization of potentially bleeding lesions, the value of the clinical history in diagnosis, the value of fecal occult blood testing, and the most appropriate diagnostic procedure for these patients. METHODS: we prospectively studied 80 patients older than 40 years with IDA, using upper gastrointestinal tract (GI) endoscopy and colonoscopy, beginning with the former (group A) or the latter (group B) depending on the clinical findings. Barium enema was done when colonoscopy was incomplete or unsatisfactory. If all these tests were negative, conventional barium contrast study of the small intestine and arteriography were done, if necessary. RESULTS: upper GI endoscopy found at least one lesion in 50 patients (72%), 13 in association with a colonic lesion (26%). Colonoscopy detected at least one lesion in 31 patients (45%), among whom 11 had another upper GI lesion (35.5%). Barium enema was positive in 4 out of 24 patients (17%). Barium contrast study of the small intestine detected lesions in 1 out of 7 patients (14%), and arteriography in 1 out of 4 patients (25%). The most common upper GI lesions were of peptic origin (esophagitis in 10, gastroduodenal erosions in 10, and peptic ulcer in 8). Neoplasms (17 cancers and 3 polyps) were the most common colonic lesion. Thirteen out of 38 patients (34%) with a potentially bleeding benign upper GI lesion had another lesion in the colon. The fecal occult blood test was positive in 9 out of 10 patients with colonic cancer and in 5 out of 9 with gastric cancer (74% positive predictive value). Nonsteroid antiinflammatory drug use did not correlate with the presence, location or type of lesion. The reliability of the clinically suspected origin of bleeding was 96% sensitivity, 43% specificity and 74% positive predictive value in group A, and 34%, 93% and 80% respectively in group B. CONCLUSIONS: lesions that cause chronic bleeding were more frequently located in the upper digestive tract than in the colon. There was a high prevalence of neoplasms in patients with IDA. One-third of the patients with a potentially bleeding benign lesion in the upper digestive tract had another lesion in the colon. A positive fecal occult blood test correlated highly with neoplastic lesions, and the presence of blood in the stool did not indicate whether bleeding originated in the upper or lower GI tract. Clinical history was of limited value in predicting the location of a bleeding lesion, but can be suggestive of a prior upper GI tract exploration. These patients need a complete study of both the upper and lower GI tracts. In patients in whom the aforementioned explorations are negative, the small bowel should be studied.     

IMMUNOCHEMICAL DETECTION OF FECAL OCCULT BLOOD

An immunochemical test for fecal occult blood has been evaluated. It has been found to be specific for human hemoglobin and to be reproducible, accurate and four times more sensitive than chemical occult blood tests. Storage of prepared slides at -20°C prevented reduction in sensitivity. To determine the effect of blood from the upper gastrointestinal tract, six volunteers ingested 100 ml of their own blood. Positive chemical, but no positive immunochemical tests were produced. In 20 healthy subjects, challenge with red meat and vegetables with high peroxidase content increased the positivity rate of chemical tests but had no effect on the positivity rate of the immunochemical test. The immunochemical method for fecal occult blood has advantages over chemical testing in that it IS specific for human blood and for lower gut bleeding. Its increased sensitivity should result in a high detection rate of colorectal neoplastic lesions. However, this same increased sensitivity may also reduce its effectiveness in bowel cancer screening because of positive results in patients with trivial blood loss from non-neoplastic colonic sources.     

Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy?

PURPOSE: There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy. SUBJECTS AND METHODS: All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed. RESULTS: During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001). CONCLUSIONS: Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia.     

Detection of upper gastrointestinal blood with fecal occult blood tests

OBJECTIVE: Although fecal occult blood (FOB) tests have most often been used to detect occult bleeding from the lower gastrointestinal (GI) tract, their utility in detecting occult blood loss from the upper GI tract is less well understood. The aims of this study were to determine whether small amounts of blood from the upper GI tract can be detected by currently available FOB tests and, if so, to correlate FOB tests with semiquantitative GI blood. METHODS: Groups of 10 healthy volunteers without a history of GI disease drank 5, 10, or 20 ml of their own blood mixed with tomato juice for 5 or 3 consecutive days. Standard dietary and medication restrictions were observed. Consecutive stools were tested for 2 days before, as well as 4 days after, blood ingestion. Each stool was simultaneously tested for FOB with HemoQuant (HQ), Hemoccult II (HO II), Hemoccult II SENSA (SENSA), HemeSelect (HS), and FlexSure OBT (FS). RESULTS: The mean age and hemoglobin concentration of the study population were 29.3+/-0.5 yr and 14.3+/-0.3 g/dl, respectively. No subject noted GI symptoms during blood ingestion. Fecal blood levels (measured by HQ) were elevated within 2 days after initiation of blood ingestion and remained elevated until 2-3 days after cessation of blood ingestion. Mean fecal blood levels peaked at 2.1, 7.9, 8.0, and 13.5 (mg hemoglobin/g stool) in groups ingesting 5 ml/5 days, 10 ml/3 days, 10 ml/5 days, and 20 ml/3 days, respectively. The proportion of positive tests during and immediately after the period of blood ingestion was greatest in the 20 ml/3 day group; 16% of HO II samples were positive as were 64% of SENSA and 67% of HQ samples. SENSA was more sensitive than HO II in all blood ingestion groups. At least one positive SENSA test was present in 50% of subjects ingesting 10 ml of blood (each 3 and 5 day groups) and in all subjects ingesting 20 ml/day. Immunochemical tests did not detect upper GI blood in any blood ingestion group. CONCLUSION: Inasmuch as many upper GI tract lesions have been reported to bleed small quantities of blood such as that studied here, and this amount of blood is readily detected with widely used guaiac-based FOB tests including Hemoccult II SENSA, the data emphasize that caution is warranted before attributing positive guaiac tests only to sites in the lower GI tract. The data raise the possibility that a combination of a highly sensitive guaiac-based FOB test plus an immunochemical could help differentiate occult upper from lower GI bleeding.     

Increased prevalence of intestinal inflammation in patients with liver cirrhosis

lNTRODUCTlONGastr0intestinalsympt0msarecomm0ninpatientswithlivercirrhosisandportalhypertensi0n.Theirpathophysiologyremains,f0rthem0stpart,obscure.Itiswellknownthates0phagealvaricesandportalhypertensiveg.,t,.p.thy[i'2jarec0mmoncausesofuppergastr0intestinal(GI)bleedinginpatientswithlivercirrh0sis.Recently,portalhypertensivecolopathy,suchascolonicvascularectasiaandrectalvarices,wererec0gnizedascausesoflowergastrointestinalbleedingincirrhoticpatients["'J.Otherthanbleeding,variouspathol0gical…