Background and Aim: There is limited data about the mucosal lesions of portal
hypertensive enteropathy (PHE) detected by capsule endoscopy (CE) as well as,
there is no scoring system to evaluate their severity. To date, there is no
published study showed the association between PHE and transient elastograhy
(TE). The aim of this study was to study the clinical impact of TE in the field of
PHE, and to create a reliable scoring system for mucosal findings of PHE
detected by CE.Materials and Methods: We compared medical records of 30
cirrhotic patients complicated with portal hypertension (PTH) with 20 control
patients who underwent CE. Our scoring system of PHE depends on
classification of small bowel(SB) mucosal lesions into main four types; 1- red
spots, 2- angioectasias, 3- SB varices, and 4- inflammatory like lesions. The first
three types comprised the vascular lesions of PHE. Each of these four lesions
worthy 2 points if it was multiple (more than 2 lesions), and only one point if it
was not. We calculated the positive points for every patient to make a final PHE
score of maximum 8 points.Results: Mucosal lesions compatible with PHE were
significantly more common in cirrhotic patients than control patients (70% vs.
10%, p 0.001). The mucosal findings in cirrhotic patients included red spots
(18 patients, 60%), angioectasias (17 patients, 56.7%), inflammatory like
abnormalities (14 patients, 46.7%), and SB varices (5 patients, 16.7%). In control
group, SB mucosal findings were present only in two patients and included red
spots (one patient, 5%) and inflammatory-like abnormalities (one patient, 5%).
Cirrhotic patients with worsening Child Pugh class, large EV, portal gastropathy,
and history of endoscopic variceal injection sclerotheraphy or ligation (EIS/
EVL)were significantly associated with PHE. Comparison between our proposed
PHE score and clinical data of patients showed that patients with higher TE score
( p 0.029), higher Child-Pugh score (p 0.027), larger EV ( p 0.013), and
prior EIS/EVL ( p 0.013) were significantly associated with higher PHE
score.Conclusions: Mucosal lesions compatible with PHE were significantly more
common in cirrhotic patients than control patients (70% vs. 10%, p 0.001).
Cirrhotic patients with high TE score, worsenig Child-Pugh, large EV, and prior
EIS/EVL are clinically associated with severe PHE. TE could be of clinical impact
in predicting severe PHE in cirrhotic patients especially if presented with occult
gastrointestinal bleeding and the esophagogastroduodenoscopy and colonoscopy
are negative.