The introduction of push enteroscopy as a practical small intestinal diagnostic tool gave the idea to conduct this study aiming to assess the small intestine in portal hypertension both endoscopically and histologically. Comparison of endoscopic and histologic data from the stomach, duodenum and jejunum was performed between 52 portal hypertensive patients and 20 age and sex matched controls. Correlations were analyzed with clinical, laboratory, sonographic and endoscopic, patients’ data in addition to etiology of the liver pathology, Child Pugh grading, barium study findings, and D-xylose absorption test. Portal hypertensive gastropathy was found in 44 patients (85%). According to our suggested endoscopic criteria of enteropathy, duodenopathy was reported in 25 cases (48%) and jejunopathy in 31 cases (60%). The histological results of the three specimens showed that patients with portal hypertension had mild to marked ectasia of mucosal vessels, edema of the lamina propria, congestion and mononuclear cell infiltration with respective frequencies of marked changes of: 14, 22, 5, 19% in the fundus, 27, 24, 13, 21% in the duodenum and 29, 25, 16, 18% for the jejunum. Controls had no or mild changes (with few exceptions) and the difference was highly significant. Endoscopic changes were not correlated with Child-Pugh grading but marked histologic changes (with exception of edema) occurred rarely in Child A. The history of sclerotherapy did not correlate with endoscopic changes but correlated positively with histological congestion in the small intestine while the etiology of portal hypertension had no effect on neither. Collaterals were associated with lower frequency of endoscopic enteropathy and histologic gastric congestion. The intercorrelation between the three organs studied was substantial in endoscopy while histological correlation was highly significant for all items. The correlation between endoscopy and histology was not significant but marked histologic changes (with exception of cellular infiltration) occurred mainly when endoscopy was positive. Marked histologic changes concerning ectasia and congestion (in the three specimens) were associated with higher means of portal vein volume flow and congestion index raising the possibility of a humoral vasodilator role of pathophysiology. We concluded that portal hypertensive enteropathy is a real entity that needs further studies and attention for better standardization of its diagnostic criteria and its clinical impact.