Non-cirrhotic Intrahepatic Portal Hypertension: Associated Gut Diseases and Prognostic Factors

• Published in: Digestive diseases and sciences 2011-01, Vol.56 (1), p.227-235
• Main Authors: Eapen, C. E, Nightingale, Peter, Hubscher, Stefan G, Lane, Peter J, Plant, Timothy, Velissaris, Dimitris, Elias, Elwyn
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Antibodies, Anticardiolipin - blood; Anticardiolipin antibodies; Biochemistry; Biological and medical sciences; Biopsy; Celiac Disease - diagnosis; Celiac Disease - epidemiology; Celiac Disease - mortality; Cohort Studies; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - epidemiology; Colitis, Ulcerative - mortality; Comorbidity; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Hypertension, Portal - diagnosis; Hypertension, Portal - epidemiology; Hypertension, Portal - mortality; Immunoglobulin A; Kaplan-Meier Estimate; Liver; Liver - pathology; Liver cirrhosis; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lupus Coagulation Inhibitor - blood; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Other diseases. Semiology; Portal hypertension; Prognosis; Regression Analysis; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Rate; Transplant Surgery; Ulcerative colitis; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-010-1278-2

Background/Aims Non-cirrhotic intrahepatic portal hypertension (NCIPH) is generally regarded to have a benign prognosis. We have studied a cohort followed-up at a tertiary referral center and postulate that gut-derived prothrombotic factors may contribute to the pathogenesis and prognosis of NCIPH. Methods We retrospectively analyzed prognostic indicators in 34 NCIPH patients. We also searched for associated gut diseases. Results Transplant-free survival in NCIPH patients from first presentation with NCIPH at 1, 5, and 10 years was 94% (SE: 4.2%), 84% (6.6%), and 69% (9.8%), respectively. Decompensated liver disease occurred in 53% of patients. Three (9%) patients had ulcerative colitis while five of 31 (16%) tested had celiac disease and on Kaplan-Meier analysis, celiac disease predicted reduced transplant-free survival (p = 0.018). On multivariable Cox regression analysis, independent predictors of reduced transplant-free survival were older age at first presentation with NCIPH, hepatic encephalopathy, and portal vein thrombosis. Prevalence of elevated initial serum IgA anticardiolipin antibody (CLPA) was significantly higher in NCIPH (36% of patients tested), compared to Budd-Chiari syndrome (6%) (p = 0.032, Fisher's exact test) and celiac disease without concomitant liver disease (0%) (p = 0.007). Conclusions We have identified prognostic factors and report progression to liver failure in 53% of NCIPH patients followed-up at our center. Our data supports a role for intestinal disease in the pathogenesis of intrahepatic portal vein occlusion leading to NCIPH.