Overlooked subclinical portal hypertension in non-cirrhotic NAFLD: Is it real and how to measure it?

Abstract

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Hepatic venous pressure gradient and rebleeding risk of patients with nonalcoholic steatohepatitis cirrhosis after variceal bleeding

“…The low level of portal pressure in NAFLD has recently attracted much attention, raising the question of whether HVPG measurements may probably be underestimated in NASH cirrhosis. Previous studies hypothesized that the potential special vasoreactivity mechanism in NAFLD reduces the effect of brosis on portal pressure [24]. NASH pathogenesis is correlated with lobular in ammation and portal brosis.…”

“…HVPG has been veri ed to contribute to the progression of cirrhotic decompensation in other etiologies. It is suggested that the threshold value of an HVPG for risk strati cation is likely to be different in NASH cirrhosis [6,24]. In this study, we evaluated the correlation between HVPG levels and cirrhotic complications in NASH cirrhosis.…”

“…Several studies have evaluated the capacity of an HVPG to correspond to liver-related complications, especially in viral and alcoholic cirrhosis, but few studies have focused on HVPG measurement in clinically decompensated NASH cirrhosis and its correlation with variceal rebleeding. The predictive value of an HVPG in previous investigations was controversial, and NASH patients had similar portal hypertensive complications at lower HVPG compared with other liver disease etiologies [6,24]. Under normal conditions, an HVPG greater than 10 mmHg predisposes patients to esophageal variceal bleeding and other portal hypertension-related complications.…”

Bibliometric-analysis visualization and review of non-invasive methods for monitoring and managing the portal hypertension

“…Notably, this study also used HVPG as a golden standard to discuss the PH diagnostic ability of LSM. However, a recent study has supposed that HVPG may underestimate the real portal pressure of patients with NASH ( 22 , 101 ), so the relationship between LSM and PPG in the patients with NASH should be further tested. As suggested by Baveno VII, the combination of LSM, platelet count, and BMI might be useful in the patients with NASH, but required further validation about proper technology, standards, and cut-offs.…”

Portal hypertension in nonalcoholic fatty liver disease: Challenges and perspectives

“…All these observations suggest that HVPG may underestimate the fibrosis stage and severity of NAFLD. Actually, the effects and manifestations of subclinical PHT, which was defined as HVPG ≥5 mmHg and HVPG < 10 mmHg, on the natural course of NAFLD, are not well understood, and the effects of subclinical PHT may have been largely overlooked 53 . That said, measurements of WHVP and HVPG are invasive and require technical expertise from the operator and equipment.…”