Non‐cirrhotic portal hypertension: Why is it so common in India?

Okuda, Kunio

doi:10.1046/j.1440-1746.2002.02660.x

Cited by 25 publications

(28 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As stated previously by Okuda [15] , the Japanese Research Committee on IPH argues against the thrombosis theory based on the following: (1) the insidious onset of IPH, (2) increased splenic blood flow in IPH (splenic blood flow is expected to decrease in portal vein thrombosis), (3) no evidence of increased thrombophilia in IPH cases, and (4) biopsy examinations of IPH cases [16] reveal a very low percentage of portal vein thrombosis (2, 3%). However, some of these points conflict.…”

Section: Thrombosis Theorymentioning

confidence: 51%

Clinical characteristics of idiopathic portal hypertension

Harmancı

Bayraktar²

2007

WJG

View full text Add to dashboard Cite

Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To inexperienced physicians, presenting esophageal varices and upper gastrointestinal bleeding usually prompt an unfortunate diagnosis of cirrhosis. A heterogenous clinical presentation and progression of this disorder should be recognized by physicians, and management should be directed towards some specific problems confined to this disorder. Although a genetic basis and other factors are implicated in its pathogenesis, exact underlying mechanism(s) is (are) unknown. In this review, we discuss the heterogeneity of idiopathic portal hypertension, its etiopathogenesis, clinical presentation and management issues. With the expectation of an excellent prognosis, a practicing gastroenterologist should be aware that "not all varices mean cirrhosis".

show abstract

Section: Thrombosis Theorymentioning

confidence: 51%

Clinical characteristics of idiopathic portal hypertension

Harmancı

Bayraktar²

2007

WJG

View full text Add to dashboard Cite

show abstract

“…The wedged hepatic venous pressure is normal or only mildly elevated. The most commonly encountered diseases in this group are NCPF {alternatively called as Idiopathic Portal Hypertension (IPH) [4]} and extrahepatic portal vein obstruction (EHPVO). Together, these two entities constitute 20-30% of total cases of portal hypertension in developing countries like India.…”

Section: Discussionmentioning

confidence: 99%

“…They suggested that the expanded plasma volume secondary to enlargement of portal bed might be closely related to the mechanism of hyperdynamic circulation. However, there are some differences in the patients with IPH and NCPF [1,4,17]. Patients with IPH are known to be of middle age, often females with the presence of auto antibodies in nearly 50% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…The condition has been commonly seen in people who are socio-economically disadvantaged. Improved hygiene and standards of living could explain the relative rarity of the disease in the West and its declining incidence in the East especially Japan [1][2][3][4]. Patients with NCPF are generally young, present with repeated attacks of well tolerated variceal bleeding and normal growth.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systemic and pulmonary hemodynamics in patients with non-cirrhotic portal fibrosis (NCPF) is similar to compensated cirrhosis

et al. 2007

View full text Add to dashboard Cite

Background Non-cirrhotic portal fibrosis (NCPF) is an important cause of portal hypertension (PHT) and variceal bleeding, especially in the developing countries. While the hepatic parenchyma and liver functions are normal, the patho-anatomic defect in these patients is pre-and peri-sinusoidal in nature. Aim To study the systemic and pulmonary hemodynamic alterations in patients with NCPF and compare them with compensated cirrhotic patients. Patients and Methods Patients with NCPF (n = 20, mean age 29.3 ± 9.8 year) and matched Child's A cirrhotic patients (n = 17, age 34.1 ± 9.8 year) who had bled in the past, underwent hemodynamic measurements using a balloon tipped catheter. Results In NCPF patients, the hepatic venous pressure gradient (HVPG) was significantly lower than in the cirrhotic patients (4.9 ± 1.5 mmHg vs. 15.7 ± 4.5 mmHg; P < 0.01). NCPF patients had hyperdynamic circulation and peripheral vasodilatation comparable to cirrhotic patients; cardiac output (8.0 ± 1.2 l/min vs. 8.4 ± 1.9 l/ min; P = 0.4), cardiac index (5.4 ± 0.8 l/min/m 2 vs. 5.5 ± 1.9 l/min/m ; P = 0.95) were comparable in the two groups. Conclusions NCPF associated portal hypertension leads to a hyperdynamic state with high cardiac index and low systemic and pulmonary vascular resistance comparable to compensated cirrhosis. These novel observations suggest a primary role of portal hypertension in the development of hyperdynamic state.

show abstract

“…It is characterized by noncirrhotic, presinusoidal, and prehepatic portal hypertension [2]. It is an important cause of portal hypertension, especially in children in the developing countries [3]. Portal vein obstruction associated with chronic liver disease or neoplasia is a separate entity and does not constitute EHPVO.…”

Section: Introductionmentioning

confidence: 99%

Systemic and pulmonary hemodynamics in patients with extrahepatic portal vein obstruction is similar to compensated cirrhotic patients

et al. 2008

View full text Add to dashboard Cite

Background Patients with cirrhosis and portal hypertension exhibit a hyperdynamic circulation manifesting as increased cardiac output, heart rate and plasma volume; and decreased arterial blood pressure, systemic vascular resistance, and pulmonary vascular resistance. It is believed that these changes are related to both hepatocellular dysfunction and portal hypertension. However, the role of portal hypertension per se in producing these changes in circulation has not been clear. Extrahepatic portal vein obstruction (EHPVO), a vascular disorder of the liver characterized by cavernomatous transformation of the main portal vein, is an excellent model to study the role of portal hypertension per se in producing these changes because there is no hepatic dysfunction in EHPVO. The main aim of our study was, therefore, to evaluate alterations of systemic and pulmonary vascular systems in patients with EHPVO and compare them with patients with compensated cirrhosis. Patients and methods Consecutive patients of EHPVO, 15 years or older, and past variceal bleeders were studied. For comparison, consecutive patients with compensated cirrhosis and history of variceal bleed, matched for variceal status, and body surface area were included. The hemodynamic studies included the measurements of cardiac index (by Fick's oxygen method), and systemic and pulmonary vascular resistance indices. Results Fifteen patients of EHPVO and same number of controls (compensated cirrhotics) were included in the study. The baseline parameters in the two groups were comparable. Both EHPVO patients and cirrhotics had similar values in all the measured systemic and pulmonary hemodynamic parameters. The median (range) cardiac index in EHPVO was 3.8 (2.3-7.7) l min -1 m -2 , whereas it was 4.4 (2.8-8.9) l min -1 m -2 in cirrhosis (P = 0.468). The median (range) systemic vascular resistance index in EHPVO was 1,835 (806-3400) dyne s cm -5 m -2 , which was similar to that in cirrhotic patients (1,800 [668-3022], P = 0.520). Similarly, the values of median (range) pulmonary vascular resistance index were comparable in the two groups (71 [42-332] vs. 79 , P = 0.885). A subgroup analysis was done for 8 patients of EHPVO and 8 age-matched compensated cirrhotic patients, which also revealed similar values of cardiac index, cardiac output, systemic vascular resistance index, systemic vascular resistance, pulmonary vascular resistance index, and pulmonary vascular resistance in the two groups. Conclusions EHPVO patients have hyperdynamic circulation manifested by high cardiac index and low systemic and pulmonary vascular resistance indices. These hemodynamic changes are comparable with compensated cirrhotic patients who have similar grade of portal hypertension. This suggests a predominant role of portal hypertension per se in the genesis of systemic and pulmonary hemodynamic alterations.

show abstract

Non‐cirrhotic portal hypertension: Why is it so common in India?

Cited by 25 publications

References 32 publications

Clinical characteristics of idiopathic portal hypertension

Clinical characteristics of idiopathic portal hypertension

Systemic and pulmonary hemodynamics in patients with non-cirrhotic portal fibrosis (NCPF) is similar to compensated cirrhosis

Systemic and pulmonary hemodynamics in patients with extrahepatic portal vein obstruction is similar to compensated cirrhotic patients

Contact Info

Product

Resources

About