In patients with liver cirrhosis and portal hypertension, portal hypertensive colopathy is thought to be an important cause of lower gastrointestinal hemorrhage. Aim of work: In this study, we evaluated the prevalence of colonic mucosal changes in patients with liver cirrhosis and its clinical significance.Methods: We evaluated the colonoscopic findings of 35 patients with liver cirrhosis and portal hypertension. All patients underwent upper GIT endoscopy to detect the presence of gastroesophageal varices, and congestive gastropathy, as well as a full colonoscopy to detect changes in colonic mucosa with endoscopic biopsy from any lesion.Results: Colonic lesions were found in 27 patients (77.1%), including hemorrhoids in 20 patients (57.1%), diffuse hyperaemic colonic mucosa in 16 patients (45.7%), angiodysplastic lesions in 12 patients (34.3%) and rectal varices in 5patients (14.3%). Bleeding per rectum was detected in 7patients (20%), significant correlation between rectal bleeding and the presence of hemorrhoids, has been found in this study. The prevalence of portal hypertensive colopathy increased with worsening Child-Pugh class and also the presence of hemorrhoids increased with worsening Child-Pugh class. Colonic hyperemia but not portal hypertensive colopathy was statistically correlated with gastroesophageal varices. The presence of rectal varices and angiodysplasia was not related to concentration of hemoglobin. No significant correlation between sex and presence of portal colopathy.