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

Znanstveni rad - Pregledni rad

• Autor: Anita Madir
• Autor: Ivica Grgurević
• Autor: Emmanuel A Tsochatzis
• Autor: Massimo Pinzani
• Autorova ustanova: Sveučilište u Zagrebu; Medicinski fakultet; (KATEDRA ZA INTERNU MEDICINU)
• Znanstveno / umjetničko područje, polje i grana: BIOMEDICINA I ZDRAVSTVO; Kliničke medicinske znanosti; Interna medicina

Sažetak (engleski)

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 fibrosis. The early development of PH in NAFLD is associated with hepatocellular lipid accumulation and ballooning, leading to the compression of liver sinusoids. External compression and intra-luminal 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 fibrosis. The 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 NAFLD. Thus, 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 patients. In 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 indication. Liver and spleen stiffness measurement in combination with platelet count is currently the best-validated non-invasive approach for diagnosing CSPH and varices needing treatment. Lifestyle change remains the cornerstone of the treatment of PH in NAFLD, together with correcting the components of metabolic syndrome, using nonselective beta blockers, whereas emerging candidate drugs require more robust confirmation from clinical trials.

• Ključne riječi (engleski): Elasticity Imaging Techniques; Humans; Hypertension, Portal / diagnosis; Hypertension, Portal / etiology; Hypertension, Portal / therapy; Liver / pathology; Liver Cirrhosis / pathology; Mechanotransduction, Cellular; Non-alcoholic Fatty Liver Disease / complications; Non-alcoholic Fatty Liver Disease / diagnosis; Non-alcoholic Fatty Liver Disease / therapy; Portal Pressure
• Jezik: engleski
• Vrsta publikacije: Znanstveni rad - Pregledni rad
• Status objave: Objavljen
• Vrsta recenzije: Recenziran
• Verzija publikacije: Objavljena verzija rada (izdavačev PDF)
• Naslov časopisa: World Journal of Gastroenterology
• Brojčani podaci: vol. 30, br. 4, str. 290-307
• p-ISSN: 1007-9327
• DOI: https://doi.org/10.3748/wjg.v30.i4.290
• URN:NBN: urn:nbn:hr:105:456496
• Datum objave publikacije: 2024-01-28
• URL dokumenta: https://www.wjgnet.com/1007-9327/full/v30/i4/290.htm
• Vrsta resursa: Tekst
• Prava pristupa: Otvoreni pristup
• Datum i vrijeme pohrane: 2024-12-03 08:12:02