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Gut microbiota shifts in hepatitis B-related portal hypertension after transjugular intrahepatic portosystemic shunt:Mechanistic and clinical implications

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World Journal of Gastroenterology 2025年第3期31卷 134-137页

作者： Qi-Rong Jiang Da-Wu Zeng Department of Hepatology Hepatology Research InstituteThe First Affiliated HospitalFujian Medical UniversityFuzhou 350005Fujian ProvinceChina Department of Infectious Diseases The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350004Fujian ProvinceChina

In this article,we provide commentary on the recent article by Zhao et *** focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and *** comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy *** gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome ***,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated *** these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal *** conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.

关键词： Hepatitis B virus Cirrhosis portal hypertension Hepatic encephalopathy Transjugular intrahepatic portosystemic shunt Gut microbiota

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portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report

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World Journal of Clinical Cases 2021年第2期9卷 496-501页

作者： Ying-Hao Chang Xiao-Lei Zhou Dan Jing Zhen Ni Shan-Hong Tang Department of Gastroenterology General Hospital of Western Theater CommandChengdu 610083Sichuan ProvinceChina Department of Infectious Diseases General Hospital of Western Theater CommandChengdu 610083Sichuan ProvinceChina

BACKGROUND Intrahepatic portosystemic venous shunt(IPSVS)is a rare hepatic disease with different clinical *** IPSVS patients with mild shunts are asymptomatic,while the patients with severe shunts present complications such as hepatic *** patients with portal hypertension accompanied by intrahepatic shunt,portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt *** SUMMARY A 57-year-old man,with the medical history of chronic hepatitis B and liver cirrhosis,was admitted to our hospital with abnormal behavior for 10 *** had received the esophageal varices ligation and entecavir therapy 1 year *** with former examination results,the degree of esophageal varices was significantly reduced,while the right branch of the portal vein was significantly expanded and ***,abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena *** imaging findings indicated the diagnosis of IPSVS and hepatic *** of radiologic interventions or surgical therapies,this patient had only accepted symptomatic *** recurrence of hepatic encephalopathy was observed during 1-year *** Hemodynamic changes may exacerbate intrahepatic portosystemic *** intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.

关键词： Intrahepatic portosystemic venous shunt portal hypertension Hepatic encephalopathy Esophageal varices Symptomatic treatment Case report Hemodynamics

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

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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 ***,several experimental and clinical studies showed evidence of portal hypertension in NAFLD without significant or advance *** 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 *** 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 *** factors such as insulin resistance and gut dysbiosis may also contribute to liver sinusoidal endothelial dysfunction and early portal hypertension in *** clinical impact of early portal hypertension in NAFLD is still ***,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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portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

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World Journal of Gastroenterology 2017年第10期23卷 1735-1746页

作者： Murad Feroz Bandali Anirudh Mirakhur Edward Wolfgang Lee Mollie Clarke Ferris David James Sadler Robin Ritchie Gray Jason Kam Wong Department of Radiology Foothills Medical Centre University of Calgary Division of Interventional Radiology Department of Radiology UCLA Medical Center

portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

关键词： portal hypertension Diagnostic imaging Portosystemic collaterals Image-guided therapy

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portal hypertension in polycystic liver disease patients does not affect wait-list or immediate post-liver transplantation outcomes

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World Journal of Gastroenterology 2016年第45期22卷 9966-9973页

作者： Neil Rajoriya Dhiraj Tripathi Joanna A Leithead Bridget K Gunson Sophie Lord James W Ferguson Gideon M Hirschfield Liver Unit Queen Elizabeth Hospital Centre for Liver Research NIHR Birmingham Liver Biomedical Research Unit University of Birmingham

AIM To establish the impact of portal hypertension(PH) on wait-list/post-transplant outcomes in patients with polycystic liver disease(PCLD) listed for liver transplantation. METHODS A retrospective single-centre case controlled study of consecutive patients listed for liver transplantation over 12 years was performed from our centre. PH in the PCLD cohort was defined by the one or more of following parameters:(1) presence of radiological or endoscopic documented varices from our own centre or the referral centre;(2) splenomegaly(> 11 cm) on radiology inabsence of splenic cysts accounting for increased imaging size;(3) thrombocytopenia(platelets portal hypertension in patients with PCLD listed for liver transplantation does not appear to have a major impact on wait-list or peri-transplant morbidity.

关键词： Polycystic liver disease portal hypertension Liver transplantation

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portal hypertension in patients with nonalcoholic fatty liver disease:Current knowledge and challenges

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World Journal of Gastroenterology 2024年第4期30卷 290-307页

作者： Anita Madir Ivica Grgurevic Emmanuel A Tsochatzis Massimo Pinzani Department of Gastroenterology Hepatology and Clinical NutritionUniversity Hospital DubravaZagreb 10000Croatia School of Medicine University of ZagrebZagreb 10000Croatia Faculty of Pharmacy and Biochemistry University of ZagrebZagreb 10000Croatia UCL Institute for Liver and Digestive Health Royal Free Hospital and University College LondonLondon NW32PFUnited Kingdom

portal hypertension(PH)has traditionally been observed as a consequence of significant fibrosis and cirrhosis in advanced non-alcoholic fatty liver disease(NAFLD).However,recent studies have provided evidence that PH may develop in earlier stages of NAFLD,suggesting that there are additional pathogenetic mechanisms at work in addition to liver *** early development of PH in NAFLD is associated with hepatocellular lipid accumulation and ballooning,leading to the compression of liver *** compression and intraluminal obstacles cause mechanical forces such as strain,shear stress and elevated hydrostatic pressure that in turn activate mechanotransduction pathways,resulting in endothelial dysfunction and the development of *** spatial distribution of histological and functional changes in the periportal and perisinusoidal areas of the liver lobule are considered responsible for the pre-sinusoidal component of PH in patients with ***,current diagnostic methods such as hepatic venous pressure gradient(HVPG)measurement tend to underestimate portal pressure(PP)in NAFLD patients,who might decompensate below the HVPG threshold of 10 mmHg,which is traditionally considered the most relevant indicator of clinically significant portal hypertension(CSPH).This creates further challenges in finding a reliable diagnostic method to stratify the prognostic risk in this population of *** theory,the measurement of the portal pressure gradient guided by endoscopic ultrasound might overcome the limitations of HVPG measurement by avoiding the influence of the pre-sinusoidal component,but more investigations are needed to test its clinical utility for this *** and spleen stiffness measurement in combination with platelet count is currently the best-validated non-invasive approach for diagnosing CSPH and varices needing *** change remains the cornerstone of the treatment of PH in NAFLD,together with correcting the comp

关键词： Non-alcoholic fatty liver disease portal hypertension Mechanotransduction Endothelial dysfunction Hepatic venous pressure gradient

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Transjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleeding

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Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 169-175页

作者： An-Ping Su Zhao-Da Zhang Bo-Le Tian Jing-Qiang Zhu Department of Thyroid Surgery West China Hospital Sichuan University Chengdu 610041 China Department of Hepatobiliopancreatic Surgery West China Hospital Sichuan University Chengdu 610041 China

BACKGROUND： Transjugular intrahepatic portosystemic shunt（TIPS） and open splenectomy and esophagogastric devascularization（OSED） are widely used to treat patients with portal hypertension and recurrent variceal bleeding（PHRVB）. This study aimed to compare the effectiveness between TIPS and OSED for the treatment of ***： The data were retrospectively retrieved from 479 cirrhotic patients（Child-Pugh A or B class） with PHRVB, who had undergone TIPS（TIPS group） or OSED（OSED group） between January 1, 2010 and October 31, ***： A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively（P=0.122）. Significantly lower incidence of pleural effusion,splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods（29 months）, significantly higher incidences of rebleeding（15.3% vs 4.6%, P=0.001） and hepatic encephalopathy（17.3% vs 3.9%, P=0.001） were observed in the TIPS group than in the OSED group. The incidence of instent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or ***： For the patients with liver function in the Child-Pugh A or B class, TIPS is not superior over OSED in terms of PHRVB treatment and rebleeding prevention.

关键词： liver cirrhosis portal hypertension recurrent variceal bleeding transjugular intrahepatic portosystemic shunt open splenectomy and esophagogastric devascularization

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Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

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World Journal of Gastroenterology 2014年第19期20卷 5794-5800页

作者： Xiao-Li Zhan Yun Ji Yue-Dong Wang Department of General Surgery Second Affiliated Hospital Zhejiang University College of Medicine

Since the first laparoscopic splenectomy(LS)was reported in 1991,LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign *** with open splenectomy,fewer postsurgical complications and better postoperative recovery have been observed,but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly,well-developed collateral circulation,and increased risk of *** the improvements of laparoscopic technique,the concept is *** article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal *** a lack of randomized controlled trial,the publications obtained have shown that with meticulous surgical techniques and advanced instruments,LS is a technically feasible,safe,and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss,shorter hospital stay,and less impairment of liver *** is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment,and the splenic artery and vein be transected en bloc with the application of the endovascular *** support the clinical evidence,further randomized controlled trials about this topic are necessary.

关键词： Laparoscopy Splenectomy Liver cirrhosis portal hypertension Hypersplenism

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Combined Laparoscopic Splenectomy and Esophagogastric Devascularization versus Open Splenectomy and Esophagogastric Devascularization for portal hypertension due to Liver Cirrhosis

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Current Medical Science 2020年第1期40卷 117-122页

作者： Hong-ping LUO Zhan-guo ZHANG Xin LONG Fei-long LIU Xiao-ping CHEN Lei ZHANG Wan-guang ZHANG Hepatic Surgery Center Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhcm 430030China

This study was conducted to compare the feasibility,safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization(C-LSED)with open splenectomy and esophagogastric devascularization surgery(OSED)in patients with portal hypertension due to liver *** February 2014 to June 2018,68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our *** patients underwent C-LSED and 38 patients received *** and outcomes were compared *** patients of C-LSED group required an intraoperative conversion to open *** shorter operating time,less blood loss,lower transfusion rates,shorter postoperative hospital stay,lower rates of complications were found in C-LSED group than in C-LSED group(P<0.05).No death and rebleeding were documented in both groups during the follow-up periods of one year Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild,and in a part of cases,the varices *** final results suggest that the C-LSED technique is superior to open procedure,due to slightly invasive,simplified operative procedure,significantly shorter operating time,less intraoperative bleeding and lower post-operative complication *** C-LSED offers comparable long-term effects to open surgery.

关键词： liver cirrhosis portal hypertension laparoscopy splenectomy esophagogastric devascularization

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Bayesian network-based survival prediction model for patients having undergone post-transjugular intrahepatic portosystemic shunt for portal hypertension

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World Journal of Gastroenterology 2024年第13期30卷 1859-1870页

作者： Rong Chen Ling Luo Yun-Zhi Zhang Zhen Liu An-Lin Liu Yi-Wen Zhang Department of Infectious Diseases Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China

BACKGROUND portal hypertension(PHT),primarily induced by cirrhosis,manifests severe symptoms impacting patient *** transjugular intrahepatic portosystemic shunt(TIPS)is a critical intervention for managing PHT,it carries risks like hepatic encephalopathy,thus affecting patient survival *** our knowledge,existing prognostic models for post-TIPS survival in patients with PHT fail to account for the interplay among and collective impact of various prognostic factors on ***,the development of an innovative modeling approach is essential to address this *** To develop and validate a Bayesian network(BN)-based survival prediction model for patients with cirrhosis-induced PHT having undergone *** The clinical data of 393 patients with cirrhosis-induced PHT who underwent TIPS surgery at the Second Affiliated Hospital of Chongqing Medical University between January 2015 and May 2022 were retrospectively *** were selected using Cox and least absolute shrinkage and selection operator regression methods,and a BN-based model was established and evaluated to predict survival in patients having undergone TIPS surgery for *** Variable selection revealed the following as key factors impacting survival:age,ascites,hypertension,indications for TIPS,postoperative portal vein pressure(post-PVP),aspartate aminotransferase,alkaline phosphatase,total bilirubin,prealbumin,the Child-Pugh grade,and the model for end-stage liver disease(MELD)*** on the above-mentioned variables,a BN-based 2-year survival prognostic prediction model was constructed,which identified the following factors to be directly linked to the survival time:age,ascites,indications for TIPS,concurrent hypertension,post-PVP,the Child-Pugh grade,and the MELD *** Bayesian information criterion was 3589.04,and 10-fold cross-validation indicated an average log-likelihood loss of 5.55 with a standard deviation of *** model’s acc

关键词： Bayesian network Cirrhosis portal hypertension Transjugular intrahepatic portosystemic shunt Survival prediction model

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