Document Detail


Non-cirrhotic portal fibrosis (idiopathic portal hypertension): experience with 151 patients and a review of the literature.
MedLine Citation:
PMID:  11895549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Non-cirrhotic portal fibrosis (NCPF), the equivalent of idiopathic portal hypertension in Japan and hepatoportal sclerosis in the United States of America, is a common cause of portal hypertension in India. The clinical features, portographic and histological findings, and management of 151 patients with non-cirrhotic portal fibrosis are presented. METHODS: The disease is diagnosed by the presence of unequivocal evidence of portal hypertension in the definite absence of liver cirrhosis and extrahepatic portal vein obstruction (EHPVO). Retrospective analysis of records of 151 patients with NCPF was analyzed for the clinical presentation, physical findings, laboratory tests, radiological and histological findings, and for the outcome of treatment. RESULTS: The disease is characterized by massive splenomegaly with anemia, preserved liver function and benign prognosis in a majority of patients. Splenoportovenography (SPV) showed massive dilatation of the portal and splenic veins, and the presence of collaterals. Twenty-four (15.9%) patients showed evidence of natural/spontaneous shunts (splenorenal 15, umbilical nine) on SPV; these patients had a lower incidence of variceal bleeding. Liver histology demonstrated maintained lobular architecture, portal fibrosis of variable degree, sclerosis and obliteration of small-sized portal vein radicles, and subcapsular scarring with the collapse of the underlying parenchyma. Piecemeal or hepatocytic necrosis was absent in all histology specimens. Three patients showed nodular transformation along with abnormal liver functions, and may represent late manifestation of NCPF where features are similar to those seen in patients with incomplete septal cirrhosis. In the initial part of the study, surgery (side-to-side lieno-renal shunt) was the preferred modality of treatment, however, endoscopic sclerotherapy or variceal ligation has now become the preferred first line of management of variceal bleeding. CONCLUSIONS: The epidemiological and clinical features of NCPF have more similarity to IPH than has previously been documented. The development of spontaneous shunts tends to protect these patients from variceal bleeding.
Authors:
Radha Krishan Dhiman; Yogesh Chawla; Rakesh Kumar Vasishta; Nandita Kakkar; Jang Bahadur Dilawari; Manjit Singh Trehan; Pankaj Puri; Somen Kumar Mitra; Sudha Suri
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  17     ISSN:  0815-9319     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-03-15     Completed Date:  2002-06-17     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  6-16     Citation Subset:  IM    
Affiliation:
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. rkpsdhiman@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Endoscopy
Female
Fibrosis
Gastrointestinal Hemorrhage / diagnosis,  etiology
Humans
Hypertension, Portal / diagnosis*,  etiology,  therapy
India
Liver / ultrasonography
Liver Cirrhosis
Liver Function Tests
Male
Middle Aged
Portal Vein / pathology*,  radiography,  ultrasonography
Sclerotherapy
Spleen / radiography
Splenomegaly / diagnosis*,  etiology
Vascular Diseases
Comments/Corrections
Comment In:
J Gastroenterol Hepatol. 2002 Jan;17(1):1-5   [PMID:  11895548 ]

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