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non cirrhotic portal hypertension

Vivian M Ussui, Lavinia Goldstein, Enrico Souto, Cynthia Levy
Portal cavernoma colangiopathy (PCC) is an uncommon cause of portal hypertension, and it is an important differential diagnosis of pancreatic malignancy given the expanded network of collateral vessels. On imaging studies, portal cavernoma can be seen as a hypoechoic mass, possibly associated with distal common bile duct obstruction. Most cases occur in non-cirrhotic patients. During the symptomatic phase, these patients carry a high-risk of complications related to sustained biliary obstruction. We report a unique patient with obstructive jaundice and a presumed pancreatic mass that proved to be a portal cavernoma complicated by PCC in the setting of nodular regenerative hyperplasia of the liver...
2018: ACG Case Reports Journal
Dimitra Taprantzi, Dimitrios Zisimopoulos, Konstantinos C Thomopoulos, Iris Spiliopoulou, Christos D Georgiou, Georgios Tsiaoussis, Christos Triantos, Charalambos A Gogos, Chrisoula Labropoulou-Karatza, Stelios F Assimakopoulos
Background: The aim of the study was to investigate the effect of propranolol on systemic oxidative stress and endotoxemia in patients with liver cirrhosis and clinically significant portal hypertension evidenced by the presence of esophageal varices. Methods: Fourteen patients with liver cirrhosis and esophageal varices, not previously been treated with non-selective beta-blockers (NSBB), were prospectively started on propranolol and followed up for three months...
March 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Rajeev Khanna, Shiv Kumar Sarin
BACKGROUND: Idiopathic portal hypertension (IPH) and extrahepatic portal venous obstruction (EHPVO) are non-cirrhotic vascular causes of portal hypertension (PHT). Variceal bleed and splenomegaly are the commonest presentations. AIM: The present review is intended to provide the existing literature on etiopathogenesis, clinical profile, diagnosis, natural history and management of IPH and EHPVO. RESULTS: IPH and EHPVO are both characterized by normal hepatic venous pressure gradient, moderate to massive splenomegaly with preserved liver synthetic functions...
February 20, 2018: Hepatology International
Tien-Ching Lin, Yen-Cheng Chiu, Hung-Chih Chiu, Wen-Chun Liu, Pin-Nan Cheng, Chiung-Yu Chen, Ting-Tsung Chang, I-Chin Wu
AIM: To investigate the utility of hepatitis B surface antigen (HBsAg) kinetics in chronic hepatitis B patients during long-term entecavir treatment. METHODS: This retrospective study included treatment-naïve chronic hepatitis B patients who received at least 2 years of consecutive entecavir treatment. Patients were followed up at three to six month intervals with liver biochemistry, hepatitis B virus DNA, and abdominal sonography. In hepatitis B e antigen (HBeAg)-positive patients, HBeAg levels were assessed every three to six month until results became negative...
February 14, 2018: World Journal of Gastroenterology: WJG
Stefania Gioia, Silvia Nardelli, Chiara Pasquale, Ilaria Pentassuglio, Valeria Nicoletti, Francesca Aprile, Manuela Merli, Oliviero Riggio
BACKGROUND: The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. AIM: To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. METHODS: The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up...
January 31, 2018: Digestive and Liver Disease
Sophie Restellini, Nicolas Goossens, Sophie Clément, Nicolas Lanthier, Francesco Negro, Laura Rubbia-Brandt, Laurent Spahr
AIM: To explore the relationship between collagen proportionate area (CPA) and portal hypertension-related clinical manifestations in alcoholic liver disease (ALD). METHODS: Retrospective study with chart review of patients with ALD adressed to our center between January 2012 and December 2013 for a transjugular liver biopsy (TJLB) and hepatic hemodynamic study. Patients were included if they met the following criteria: (1) Medical indication for a liver biopsy in the setting of ALD; (2) recent (< 15 d) clinical, radiological, endoscopic and biological data available; and (3) estimated follow-up of at least 6 mo...
January 27, 2018: World Journal of Hepatology
Peter Deibert, Adhara Lazaro, Zoran Stankovic, Denise Schaffner, Martin Rössle, Wolfgang Kreisel
Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored...
January 21, 2018: World Journal of Gastroenterology: WJG
Abdulrhman S Elnaggar, Adam D Griesemer, Stuart Bentley-Hibbert, Robert S Brown, Mercedes Martinez, Steven J Lobritto, Tomoaki Kato, Jean C Emond
OBJECTIVE: To characterize the relationship between portal vein thrombosis (PVT) and hepatic atrophy in the non-cirrhotic patients and the effect of various types of surgical shunts on liver regeneration and splenomegaly. BACKGROUND: Non-cirrhotic patients with PVT suffer from presinusoidal portal hypertension and often hepatic atrophy, a topic that has received little attention. We hypothesized that patients with PVT have decreased liver volumes, and shunts that preserve intrahepatic portal flow enhance liver regeneration...
January 29, 2018: Liver Transplantation
Natalie Lucchina, Chiara Recaldini, Monica Macchi, Valeria Molinelli, Mario Montanari, Sergio Segato, Raffaele Novario, Carlo Fugazzola
The goals of the study described here were to evaluate the feasibility and reproducibility of measuring spleen stiffness (SS) using point shear wave elastography in a series of cirrhotic patients and to investigate whether SS, liver stiffness (LS) and other non-invasive parameters are correlated with the presence of esophagogastric varices (EVs). Fifty-four cirrhotic patients with low-grade EVs or without EVs at esophago-gastro-duodenoscopy were enrolled. They underwent abdominal ultrasound and Doppler ultrasound of hepatic vessels simultaneously with p-SWE of the liver and spleen...
January 15, 2018: Ultrasound in Medicine & Biology
Won Hyeok Choe, Jeong Hwan Kim, Jung Ho Park, Heung Up Kim, Dae Hyeon Cho, Sang Pyo Lee, Tae Yoon Lee, Sun-Young Lee, In Kyung Sung, Hyung Seok Park, Chan Sup Shim
BACKGROUND AND OBJECTIVES: Endoscopic submucosal dissection (ESD) has become widely accepted method for treating early gastric cancer (EGC), but little is known about its role in patients with liver cirrhosis (LC). The aims of this study were to evaluate the outcomes of ESD in treating EGC in patients with LC. METHODS: The multicenter retrospective study identified 43 patients with chronic hepatitis B (CHB)-related cirrhosis undergoing ESD for treating EGC. The patients (LC group) were subdivided into two groups based on their Child-Pugh classification (CP-class): 32 with CP-class A (LC-A) and 11 with CP-class B (LC-B)...
December 27, 2017: Digestive Diseases and Sciences
Víctor Molina, Jaime Sampson-Dávila, Joana Ferrer, Constantino Fondevila, Rafael Díaz Del Gobbo, David Calatayud, Jordi Bruix, Juan Carlos García-Valdecasas, Josep Fuster
BACKGROUND: The advantages of laparoscopy over open liver resection in patients with cirrhosis have been widely demonstrated. On the other hand, information on the role of minimally invasive liver surgery in the presence of clinically significant portal hypertension (CSPH) is scarce. The aim of this study was to evaluate the role of laparoscopic liver resection in selected cirrhotic patients with CSPH. METHODS: A retrospective case-control study of cirrhotic patients with hepatocellular carcinoma who were treated with laparoscopic liver resection was conducted from December 2005 to April 2016...
December 7, 2017: Surgical Endoscopy
N Patel, A Grieve, J Hiddema, J Botha, J Loveland
BACKGROUND: Portal hypertension is a common and potentially devastating condition in children. Notwithstanding advances in the nonsurgical management of portal hypertension, surgery remains an important treatment modality in select patients. We report here on our experience in the past 12 years. OBJECTIVES: To describe the profile of, indication for, and complications of shunt surgery in children with portal hypertension. METHODS: Twelve children underwent shunt surgery between 2005 and 2017...
November 6, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Ana Luísa Pinto, Marília Gomes, Maria Augusta Cipriano, Maria Letícia Ribeiro
No abstract text is available yet for this article.
November 17, 2017: Acta Oncologica
Cyriac Abby Philips, Lijesh Kumar, Philip Augustine
INTRODUCTION: Large spontaneous portosystemic shunts (SPSS) are seen in a subset of patients with liver disease and medically refractory recurrent/persistent hepatic encephalopathy (MRHE). Shunt occlusion has been shown to improve clinical outcomes. METHODS: We retrospectively analyzed patient characteristics, SPSS attributes, procedural features, baseline clinical and investigational parameters, neurological outcomes, adverse effects (procedure and portal hypertension related), and risk factors predicting outcomes in liver disease patients undergoing shunt occlusion procedure for MRHE...
September 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Cecilia Marconi, Mattia Bellan, Paola Giarda, Rosalba Minisini, Serena Favretto, Michela Emma Burlone, Lisa Franzosi, Mario Pirisi
Background: Cirrhotic cardiomyopathy is characterized by a set of cardiovascular modifications observed in advanced chronic liver disease. The aim of this study was to investigate cardiovascular alterations in chronic liver disease with different stages of fibrosis and to correlate cardiac involvement with endoscopic complications of portal hypertension. Methods: Seventy patients with chronic hepatitis C-related chronic liver disease and 20 sex- and age-matched controls underwent clinical evaluation, hepatic transient elastography, and echocardiography...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Christoph Klinger, Bettina Riecken, Arthur Schmidt, Andrea De Gottardi, Benjamin Meier, Jaime Bosch, Karel Caca
Purpose To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). Methods This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1)...
November 7, 2017: Zeitschrift Für Gastroenterologie
Eylon Lahat, Chetana Lim, Prashant Bhangui, Liliana Fuentes, Michael Osseis, Toufic Moussallem, Chady Salloum, Daniel Azoulay
BACKGROUND: Portal hypertension (PHTN) increases the risk of non-hepatic surgery in cirrhotic patients. This first systematic review analyzes the place of transjugular intrahepatic portosystemic shunt (TIPS) in preparation for non-hepatic surgery in such patients. METHODS: Medline, EMBASE, and Scopus databases were searched from 1990 to 2017 to identify reports on outcomes of non-hepatic surgery in cirrhotic patients with PHTN prepared by TIPS. Feasibility of TIPS and the planned surgery, and the short- and long-term outcomes of the latter were assessed...
October 27, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Stefano Gitto, Valeria Guarneri, Alessandro Sartini, Pietro Andreone
Farnesoid X nuclear receptor is involved in the regulation of lipid and glucose metabolism, though mainly in the homeostasis of bile acids. Indeed, the agonists of farnesoid X nuclear receptor represent promising drugs. Areas covered: Obeticholic acid, a novel semi-synthetic analogue of the naturally occurring bile acid, has led to encouraging preliminary results in both cholestatic and metabolic liver disease. In patients with primary biliary cholangitis, obeticholic acid determines a significant biochemical improvement although the effects on liver fibrosis are lacking...
October 30, 2017: Expert Review of Gastroenterology & Hepatology
Ashish Goel, V Raghupathy, G J Amirtharaj, Aaron Chapla, Aparna Venkatraman, Banumathi Ramakrishna, Anup Ramachandran, Nihal Thomas, K A Balasubramanian, Ian Mackie, Elwyn Elias, Chundamannil E Eapen
BACKGROUND: Non-cirrhotic intrahepatic portal hypertension (NCIPH) is characterized by thrombotic microangiopathy of the portal venous system, low ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs-13), and high vWF (von Willebrand factor) levels. This study aimed to screen for ADAMTS13 mutations, focusing on the CUB domain, in these patients. METHODS: Prospectively recruited NCIPH patients and healthy volunteers underwent tests for plasma vWF-ADAMTS13 balance...
September 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Praveen Sharma, Rachit Agarwal, Shashi Dhawan, Naresh Bansal, Vikas Singla, Ashish Kumar, Anil Arora
BACKGROUND: Non-cirrhotic portal hypertension (NCPH) is a common cause of variceal bleed in developing countries. Transient elastography (TE) using Fibroscan is a useful technique for evaluation of fibrosis in patients with liver disease. There is a paucity of studies evaluating TE in patients with Non-cirrhotic portal fibrosis (NCPF) and none in Asian population. Aim of this study was to evaluate role of TE in NCPF. METHODS: Retrospective data of consecutive patients of NCPF as per Asian pacific association for the study of liver (APASL) guidelines were noted...
September 2017: Journal of Clinical and Experimental Hepatology
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