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Portal hypertension in Nonalcoholic Fatty Liver Disease:From Pathogenesis to Clinical Practice

Journal of Clinical and Translational hepatology 2022年第5期10卷 979-985页

作者： saut horas h.nababan Cosmas Rinaldi Adithya Lesmana hepatobiliary Division Department of Internal MedicineDr Cipto Mangunkusumo National General HospitalMedical Faculty Universitas IndonesiaJakartaIndonesia Gastrointestinal Cancer Center MRCCC Siloam Semanggi HospitalJakartaIndonesia Digestive Disease&GI Oncology Center Medistra HospitalJakartaIndonesia

Portal hypertension in nonalcoholic fatty liver disease(NAFLD)mostly occur in cirrhotic stage.however,several experimental and clinical studies showed evidence of portal hypertension in NAFLD without significant or advance fibrosis.This early development of portal hypertension in NAFLD is associated with liver sinusoidal contraction by hepatocellular lipid accumulation and ballooning,which is also accompanied by capillarization and dysfunction of liver sinusoidal endothelial cells.Both of these impaired mechanical and molecular components can cause an increase in intrahepatic vascular resistance which lead to the increase of portal pressure in the absence of significant liver fibrosis.Extrahepatic factors such as insulin resistance and gut dysbiosis may also contribute to liver sinusoidal endothelial dysfunction and early portal hypertension in NAFLD.The clinical impact of early portal hypertension in NAFLD is still unclear.however,clinical tools for diagnosis and monitoring of portal hypertension in NAFLD are being investigated to predict high-risk patients and to guide therapy.

关键词： Portal hypertension NAFLD NASh Metabolic

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Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment:A case series

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Portal hypertension & Cirrhosis 2022年第1期1卷 76-81页

作者： Cosmas Rinaldi A.Lesmana saut h.nababan Kemal F.Kalista Juferdy Kurniawan Chyntia O.M.Jasirwan Andri S.Sulaiman Irsan hasan Rino A.Gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalJakartaIndonesia Digestive Disease and GI Oncology Center Medistra HospitalJakartaIndonesia

Aim:The presence of esophageal collateral veins(ECV)has been reported to be associated with the recurrence of esophageal varices(EV)and bleeding in liver cirrhotic(LC)patients.This study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound(EUS)in liver cirrhotic patients with EV.Methods:During 6 months period,a prospective study is conducted,where we identified LC patients who were admitted for esophagogastroduodenoscopy(EGD)screening at the Department of Internal Medicine,Dr.Cipto Mangunkusumo National General hospital,Jakarta.ECV was examined using EUS.Patients were excluded if they had(1)liver malignancy,(2)history of ligation or glue injection,or(3)portal or splenic vein thrombus.We collected demographic data,medical history,data pertaining to use of nonselective beta blocker(NSBB),and laboratory,imaging,and endoscopy results.EGD was performed using a gastroscope(EG29‐i10,3.2 mm Pentax Medical)while EUS was performed using a linear array echoendoscope(EG‐3870UTK,3.8 mm,Pentax Medical)before band ligation or glue injection.Results:There were 20 LC patients included in this study,where 15(75%)of patients were classified with Child-Pugh(CP)‐A and five(25%)of patients with CP‐B.The most common aetiologies were hepatitis B in seven(35%)patients and hepatitis C in nine(45%)patients.The EV with peri‐or para‐esophageal veins(PEEV or PAEV)were detected in 65%of patients.None of the LC patients with no EV showed the presence of ECV.PEEV or PAEV were detected in grades 1-3 EV.Conclusion:EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.

关键词： endoscopic ultrasound esophageal collateral vein gastroesophageal varices liver cirrhosis portal hypertension

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