Biomarkers and imaging studies to predict portal hypertension and varices

Lee, Christine K.

doi:10.1002/cld.627

Cited by 2 publications

(2 citation statements)

References 22 publications

(31 reference statements)

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“…An academic definition of PH is portal vein pressure higher than 5 mmHg. 15 Nevertheless, to measure this pressure, it is necessary to introduce a venous catheter into the suprahepatic veins. However, this technique for the diagnosis of PH syndrome is not usually performed outside of specialized hemodynamic and transplantation liver units.…”

Section: Discussionmentioning

confidence: 99%

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

Aliaga

Romero‐Alegría

Alonso‐Sardón

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1–20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

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Section: Discussionmentioning

confidence: 99%

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

Aliaga

Romero‐Alegría

Alonso‐Sardón

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…Several excellent reviews summarize in detail these efforts to discover non-invasive biomarkers for the assessment of portal hypertension and cirrhosis [99,100,103]. Notably though, very few studies have used large-scale -omics technologies and integrative systems biology approaches in patients with portal hypertension and especially with those at early stages.…”

Section: Emerging Biomarkers Of Portal Hypertensionmentioning

confidence: 99%

Nonalcoholic fatty liver disease and portal hypertension

Ryou

Stylopoulos

Baffy

2020

Exploration of Medicine

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Nonalcoholic fatty liver disease (NAFLD) is a substantial and growing problem worldwide and has become the second most common indication for liver transplantation as it may progress to cirrhosis and develop complications from portal hypertension primarily caused by advanced fibrosis and erratic tissue remodeling. However, elevated portal venous pressure has also been detected in experimental models of fatty liver and in human NAFLD when fibrosis is far less advanced and cirrhosis is absent. Early increases in intrahepatic vascular resistance may contribute to the progression of liver disease. Specific pathophenotypes linked to the development of portal hypertension in NAFLD include hepatocellular lipid accumulation and ballooning injury, capillarization of liver sinusoidal endothelial cells, enhanced contractility of hepatic stellate cells, activation of Kupffer cells and pro-inflammatory pathways, adhesion and entrapment of recruited leukocytes, microthrombosis, angiogenesis and perisinusoidal fibrosis. These pathological events are amplified in NAFLD by concomitant visceral obesity, insulin resistance, type 2 diabetes and dysbiosis, promoting aberrant interactions with adipose tissue, skeletal muscle and gut microbiota. Measurement of the hepatic venous pressure gradient by retrograde insertion of a balloon-tipped central vein catheter is the current reference method for predicting outcomes of cirrhosis associated with clinically significant portal hypertension and guiding interventions. This invasive technique is rarely considered in the absence of cirrhosis where currently available clinical, imaging and laboratory correlates of portal hypertension may not reflect early changes in liver hemodynamics. Availability of less invasive but sufficiently sensitive methods for the assessment of portal venous pressure in NAFLD remains therefore an unmet need. Recent efforts to develop new biomarkers and endoscopy-based approaches such as endoscopic ultrasound-guided measurement of portal pressure gradient may help achieve this goal. In addition, cellular and molecular targets are being identified to guide emerging therapies in the prevention and management of portal hypertension.

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Biomarkers and imaging studies to predict portal hypertension and varices

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-4-reading-lee.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-4-interview-lee.html the interview with the author

Cited by 2 publications

References 22 publications

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

Nonalcoholic fatty liver disease and portal hypertension

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