Relationship of portal pressure and colorectal vasculopathy in patients with cirrhosis.

We studied the relationship between portal pressure and colorectal mucosal vascular lesions in cirrhotics and the effectiveness of drug therapy in treating these lesions. Colonoscopy and hepatic venous pressure gradient (HVPG) studies were performed in 21 cirrhotics. Oral spironolactone plus transdermal nitroglycerin were given to patients who had diffuse mucosal cherry-red spots and/or rectal varices. The colonoscopy and HVPG determinations were repeated after four weeks. Colonoscopic findings included vascular ectasias in 13 patients (62%), diffuse cherry-red spots in the rectum in five patients (24%), and rectal varices in eight patients (38%). Overall, colorectal mucosal vascular lesions were found in 16 cirrhotics (76%). These findings were not found in 21 age- and sex-matched noncirrhotic controls. Vascular ectasias appeared without relationship to the HVPG. Patients with diffuse cherry-red spots (N = 5, 22.4+/-3.4 mm Hg) had a significantly higher HVPG than those without (N = 16, 16.6+/-3.3 mm Hg, P < 0.01). However, no significant difference was found in HVPG between patients with rectal varices (N = 8, 19.4+/-4.6 mm Hg) and patients without rectal varices (N = 13, 17.2+/-3.8 mm Hg). After four weeks of drug therapy, diffuse cherry-red spots became less obvious when the HVPG decreased more than 20%. Rectal varices did not change their appearance with HVPG reduction. We found that colorectal vascular lesions are common in cirrhotics. Diffuse cherry-red spots are probably dependent on elevated portal pressure, but vascular ectasias and rectal varices are not related to the degree of portal pressure. Chronic drug therapy with reduction of portal pressure improves colonoscopic findings such as diffuse cherry-red spots.