Colonoscopy in Amoebic Liver Abscess: Clinical Significance of Colonic Pathology

Introduction Amoebiasis, caused by <i>Entamoeba histolytica</i>, remains a significant global health concern, particularly in endemic regions such as India. An amoebic liver abscess (ALA) is the most common extraintestinal manifestation of amoebiasis, often linked to colonic pathology. However, the correlation between hepatic and colonic involvement is underexplored, leading to missed diagnostic opportunities and suboptimal management. This study investigates the clinical significance of colonic pathology in ALA patients through colonoscopic evaluations. Materials and methods This observational study included 110 ALA patients evaluated over 3.5 years in a tertiary care hospital in Gujarat, India. Patients underwent colonoscopy within 48 hours of initiating anti-amoebic treatment. Data on demographic characteristics, clinical presentations, and colonoscopic findings were analyzed using descriptive and inferential statistical methods. Inclusion criteria encompassed adult patients diagnosed with ALA, while those with pyogenic liver abscesses or contraindications to colonoscopy were excluded. The ethical approval and informed consent ensured compliance with research standards. Results and discussion Colonic abnormalities were identified in 55.45% of patients with ALA, with ulceration being the most common (33.64%). Larger abscesses (>10 cm) and multiple liver abscesses were significantly associated with colonic pathology (p = 0.002 and p = 0.019, respectively), particularly in the right lobe (p = 0.037). Middle-aged patients (31-50 years) had the highest prevalence (100%), while males were more affected than females (4.64:1), likely due to risk factors like alcoholism and obesity. Patients with multiple abscesses had greater odds of colonic findings (OR = 3.09), as did those with larger abscesses (OR = 4.67). These findings emphasize the importance of colonoscopy in high-risk patients to improve diagnosis and treatment strategies. Conclusion This study links colonic pathology in ALA to age, sex, and abscess characteristics, highlighting higher prevalence in middle-aged males and those with larger or multiple abscesses. Despite limitations, it underscores colonoscopy's role in improving diagnosis and management.