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non cirrhotic portal hypertension

Driss Raissi, Elizabeth A Roney, Mohamed M Issa, Sreeja Sanampudi, Michael A Winkler
Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan...
October 27, 2018: Clinical Imaging
J G Abraldes, J Trebicka, N Chalasani, G D'Amico, D Rockey, V Shah, J Bosch, G Garcia-Tsao
Portal hypertension is the main driver of cirrhosis decompensation, the main determinant of death in patients with cirrhosis. Portal hypertension results initially from increased intrahepatic vascular resistance. Later, increased inflow from splanchnic vasodilation and increased cardiac output lead to a further increase in portal pressure. Reducing portal pressure in cirrhosis results in better outcomes. Removing the cause of cirrhosis might improve portal pressure. However, this is a slow process and patients may continue to be at risk of decompensation...
October 15, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Peter Lykke Eriksen, Anne Luise Hartkopf-Mikkelsen, Peter Ott, Hendrik Vilstrup, Niels Kristian Aagaard
Background: Terlipressin is used as pharmacological treatment for variceal bleeding. The drug's physiological effect favours hyponatremia, and rapid changes in plasma sodium (PNa) may cause brain injury. Cirrhosis patients seem to be largely protected against this effect but patients without cirrhosis may not be so. Objective: The objective of this study was to examine whether terlipressin treatment of patients without cirrhosis leads to more serious fluctuations in PNa than in cirrhosis...
October 2018: United European Gastroenterology Journal
Tilman Sauerbruch, Florence Wong
BACKGROUND: The development of cirrhosis with resultant portal hypertension can lead to oesophageal varices at a rate of 7% per annum. Bleeding from varices happens when the portal pressure is ≥12 mm Hg and can threaten life. SUMMARY: Eliminating the aetiology of cirrhosis is a pivotal step to prevent the formation of varices. In patients with established varices, primary prophylaxis with non-selective beta blockers (NSBB) may slow down the progression of varices and prevent the first variceal bleed...
September 13, 2018: Digestion
Du Kong, Wei Wang, Gang Du, Binyao Shi, Zhengchen Jiang, Bin Jin
Background: Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension...
2018: BioMed Research International
Luca Viganò, Fabio Procopio, Antonio Mimmo, Matteo Donadon, Alfonso Terrone, Matteo Cimino, Daniele Del Fabbro, Guido Torzilli
BACKGROUND: The superiority of anatomic resection compared with nonanatomic resection for hepatocellular carcinoma remains a matter of debate. Further, the technique for anatomic resection (dye injection) is difficult to reproduce. Anatomic resection using a compression technique is an easy and reversible procedure based on liver discoloration after ultrasound-guided compression of the tumor-feeding portal tributaries. We compared the oncologic efficacy of compression technique anatomic resection with that of nonanatomic resection...
November 2018: Surgery
Yu-Hsin Hsieh, Hui-Chun Huang, Ching-Chih Chang, Chiao-Lin Chuang, Fa-Yauh Lee, Shao-Jung Hsu, Yi-Hsiang Huang, Ming-Chih Hou, Shou-Dong Lee
Chronic hepatitis is the major cause of liver cirrhosis and portal hypertension. Several factors affect portal pressure, including liver fibrosis, splanchnic vasodilatation and pathological angiogenesis. Nucleos(t)ide analogs (NUCs), the oral antiviral agents, effectively attenuate chronic hepatitis B-related liver cirrhosis and portal hypertension via viral suppression and alleviation of hepatitis. On the other hand, NUCs affect TNF-α, vascular endothelial growth factor (VEGF) and nitric oxide, which participate in fibrogenesis, vasodilatation and angiogenesis...
September 7, 2018: Journal of Pharmacology and Experimental Therapeutics
Clemens Heiser, Bernhard Haller, Maximilian Sohn, Benedikt Hofauer, Andreas Knopf, Tobias Mühling, Jessica Freiherr, Martin Bender, Maximilian Tiller, Anna Schmidt, Wolfgang Schepp, Felix Gundling
INTRODUCTION AND AIM: Olfactory functions are altered to a variable degree by chronic liver disease. Few studies including only small populations of patients emphasized the possibility of hepatic encephalopathy (HE) influencing olfactory nervous tasks. So far, no study has explicitly focused on olfactory function depending on the severity of HE as assessed by objective diagnostic procedures. Thus we performed a study using the "Sniffin' Sticks" test system, critical flicker-fusion frequency (CFF) and clinical West Haven criteria...
August 24, 2018: Annals of Hepatology
Filipe Andrade, Akash Shukla, Christophe Bureau, Marco Senzolo, Louis D'Alteroche, Alexandra Heurgué, Juan-Carlos Garcia-Pagan, Fanny Turon, Frédéric Oberti, Dhiraj Tripathi, Olivier Roux, Pierre-François Ceccaldi, Emmanuelle de Raucourt, Audrey Payancé, Dominique Valla, Aurélie Plessier, Pierre-Emmanuel Rautou
BACKGROUND & AIMS: A total of 15% of patients with idiopathic non-cirrhotic portal hypertension (INCPH) are women of childbearing age. We aimed to determine maternal and fetal outcome of pregnancies occurring in women with INCPH. METHODS: We retrospectively analyzed the charts of women with INCPH followed in the centers of the VALDIG network, having had ≥1 pregnancy during the follow-up of their liver disease. Data are represented as median (interquartile range)...
August 21, 2018: Journal of Hepatology
Virginia C Clark, George Marek, Chen Liu, Amy Collinsworth, Jonathan Shuster, Tracie Kurtz, Joanna Nolte, Mark Brantly
BACKGROUND & AIMS: Alpha-1 antitrypsin deficiency (AATD) is an uncommonly recognized cause of liver disease in adults, with descriptions of its natural history limited to case series and patient-reported data from disease registries. Liver pathology is limited to selected patients or unavailable. Therefore, we aimed to determine the prevalence and severity of liver fibrosis in an adult AATD population who were not known to have cirrhosis, while defining risk factors for fibrosis and testing non-invasive markers of disease...
August 21, 2018: Journal of Hepatology
Maria Guido, Venancio A F Alves, Charles Balabaud, Prithi S Bathal, Paulette Bioulac-Sage, Romano Colombari, James M Crawford, Amar P Dhillon, Linda D Ferrell, Ryan M Gill, Prodromos Hytiroglou, Yasuni Nakanuma, Valerie Paradis, Alberto Quaglia, Pierre E Rautou, Neil D Theise, Swan Thung, Wilson M S Tsui, Christine Sempoux, Dale Snover, Dirk J van Leeuwen
Idiopathic non-cirrhotic portal hypertension (INCPH) is a rare vascular liver disease that has attracted new interest in recent years. It is characterised by clinical signs of portal hypertension in the absence of cirrhosis or severe fibrosis and any known cause of portal hypertension. As much uncertainty exists about INCPH pathophysiology, and no definite diagnostic tests are available, liver biopsy is an essential tool for achieving a definite diagnosis. Unfortunately, the histological diagnosis of INCPH is not always straightforward, as the characteristic lesions are unevenly distributed, vary greatly in their severity, are often very subtle, and are not all necessarily present in a single case...
August 21, 2018: Histopathology
Jia Hao Law, Jarrod Kah Hwee Tan, Kien Yee Michael Wong, Wan Qi Ng, Poh Seng Tan, Glenn Kunnath Bonney, Shridhar Ganpathi Iyer, Madhavan Krishnakumar, Wei Chieh Alfred Kow
BACKGROUND: To compare the presentations and outcomes of anti-HBc seropositive Hepatocellular Carcinoma (HBc-HCC) with anti-HBc seronegative (NHBc-HCC) patients in HBsAg negative Non-HBV Non-HCV (NBNC-HCC) HCC population. METHODS: 515 newly diagnosed HCC patients from January 2011 to September 2016 were retrospectively reviewed. 145 (66.5%) NHBc-HCC and 73 (33.5%) HBc-HCC patients were identified. Patient demographics, disease characteristics, details of treatments, recurrence and survival outcomes were analysed...
August 4, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Elsaid Wasfy, Galal Elkassas, Sally Elnawasany, Kariman Elkasrawy, Sherief Abd-Elsalam, Shaimaa Soliman, Rehab Badawi
Background& Aims: Esophageal varices (EV) are a major complication of portal hypertension in cirrhotic patients. Screening is essential for all patients with cirrhosis. Performing non-invasive methods for screening is a cost-effective and time-saving measure. The aim of this work is to evaluate whether insulin resistance (IR) assessed by HOMA-IR score can predict the presence of EV or not. METHODS: This cross-sectional study was carried out on sixty Egyptian cirrhotic HCV patients divided into 3 groups: Group I: 20 cirrhotic patients without esophageal varices, Group II: 20 cirrhotic patients, with small esophageal varices and Group III: 20 cirrhotic patients with large esophageal varices...
August 3, 2018: Endocrine, Metabolic & Immune Disorders Drug Targets
George Boon-Bee Goh, Philip R Schauer, Arthur J McCullough
With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery...
July 28, 2018: World Journal of Gastroenterology: WJG
Raj Vuppalanchi, Karan Mathur, Maximillian Pyko, Niharika Samala, Naga Chalasani
Non-cirrhotic portal hypertension (NCPH) is often a diagnostic challenge due to signs and symptoms of portal hypertension that overlap with cirrhosis. The etiology of NCPH is broadly classified as prehepatic, hepatic (pre-sinusoidal and sinusoidal) and post-hepatic.1 Some common etiologies of NCPH encountered in clinical practice include portal vein thrombosis (prehepatic) and nodular regenerative hyperplasia (NRH) (hepatic). This article is protected by copyright. All rights reserved.
July 17, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Michael Sørensen, Lars P Larsen, Gerda E Villadsen, Niels K Aagaard, Henning Grønbæk, Susanne Keiding, Hendrik Vilstrup
BACKGROUND: Presinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas β-blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown. AIMS: To evaluate the hemodynamic effect of β-blockers in non-cirrhotic patients with presinusoidal portal hypertension. METHODS: We measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off β-blocker treatment (random sequence)...
July 12, 2018: Digestive Diseases and Sciences
C Y He, Y Lyu, H Chen, H B Liu, Q H Wang, J H Fan, B H Luo, T L Yu, X L Yuan, J Tie, J Niu, W G Guo, Z X Yin, G H Han
No abstract text is available yet for this article.
April 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
X L Qi
The non-invasive era of portal hypertension in cirrhosis is approaching. We should seize the opportunity: then do learn to follow the recommended international guidelines for emerging non-invasive technologies and systematically utilize case resources of our country's for clinical verification; Secondly, we should pay attention to the cross-theory innovation of the middle level discipline in the process of technology development, and standardize the design and clinical registration in accordance with international diagnostic testing standards; Finally, a non-invasive technique for the treatment of cirrhotic portal hypertension was developed with a developmental perspective, enabling the transition from disease diagnosis and risk stratification to efficacy monitoring and prognosis prediction...
April 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Lucas Souto Nacif, Denise C Paranagua-Vezozzo, Alina Matsuda, Venancio Avancini Ferreira Alves, Flair J Carrilho, Alberto Queiroz Farias, Luiz Carneiro D'Albuquerque, Wellington Andraus
BACKGROUND: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. AIM: To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. METHOD: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography...
June 21, 2018: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Jonel Trebicka
No abstract text is available yet for this article.
August 2018: Digestive and Liver Disease
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