Objective To evaluate the rate of colonoscopy-based diagnosis of portal hypertensive colopathy (PHC) in patients with cirrhosis and evaluate associations with the hepatic disease pathogenic features.Methods Twenty-three cirrhotic patients who underwent colonoscopy between January 2009 and May 2012 were enrolled in the study.The colonoscopy examination results, Child-Pugh scores, esophageal varices stages, and aspartate aminotransferase to platelet ratio index (APRI) values were recorded for each patient.The significance of inter-group differences was assessed by Chi-squared test or Fisher′s exact test.Results The most common colonoscopy finding was PHC (9/23, 39.1%) .Only 8.7% (2/23) of patients had completely normal findings.Occurrence of PHC was associated with moderate to severe esophageal varices (P=0.086) but not with severe liver fibrosis, either by APRI index or Child-Pugh score.Conclusion The majority of cirrhosis patients had anomalous colonoscopy findings, and more than one-third had PHC.Colonoscopy should be considered for cirrhotic patients to identify previously undiagnosed PHC and initiate timely treatment.