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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 7, 2008; 14(41): 6370-6375
Published online Nov 7, 2008. doi: 10.3748/wjg.14.6370
Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension
Jamilé Wakim-Fleming, Nizar N Zein, Ana Bennett, Rocio Lopez, Janice Santisi, William D Carey
Jamilé Wakim-Fleming, Nizar N Zein, Janice Santisi, William D Carey, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States
Ana Bennett, Department of Pathology/Immunology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States
Rocio Lopez, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States
Author contributions: Wakim-Fleming J, Zein NN and Carey WD wrote the paper and contributed to data analysis; Lopez R conducted statistical analysis; Wakim-Fleming J and Santisi J performed research; Bennett A conducted pathological studies.
Correspondence to: Jamilé Wakim-Fleming, MD, FACG, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, A30, 9500 Euclid Avenue, Cleveland, Ohio 44195, United States. fleminj1@ccf.org
Telephone: +1-216-4441764 Fax: +1-216-4455477
Received: August 14, 2008
Revised: October 17, 2008
Accepted: October 24, 2008
Published online: November 7, 2008
Abstract

AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria.

METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence.

RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension.

CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

Keywords: Cirrhosis; Portal hypertension; Coeliac disease; Marsh criteria; Small bowel mucosa