Portal Hypertensive Colopathy: Diagnostic Challenges and Management in Cirrhosis.

Purpose of review: This review summarizes the current understanding of portal hypertensive colopathy (PHC), highlights the clinical and endoscopic presentation, treatment options to be considered and areas for future investigation.

Recent findings: Portal hypertensive colopathy (PHC) is an underrecognized consequence of portal hypertension in cirrhosis. It frequently presents with subtle gastrointestinal symptoms, such as iron deficiency anemia or intermittent rectal bleeding, and is often misattributed to more common etiologies like hemorrhoids or diverticular disease. PHC is a diagnosis made endoscopically and is characterized by erythema of the colonic mucosa, vascular lesions and colon varices. Management focuses on portal pressure reduction, endoscopic colon therapies and intra-vascular procedures. Due to a lack diagnostic criteria, the true prevalence of PHC is unknown but has been reported to be up to 71% among cirrhotic patients. The management of acute bleeding from PHC is based on case reports, case series and expert opinion. PHC should be considered in all cirrhotic patients with unexplained lower GI bleeding or chronic anemia. A high index of suspicion is required in order to make a timely and accurate diagnosis.