Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance

Zardi, Enrico Maria; Uwechie, Valentina; Caccavo, Domenico; Pellegrino, N. M.; Cacciapaglia, Fabio; Matteo, Francesco Di; Dobrina, Aldo; Laghi, V.; Afeltra, Antonella

doi:10.1007/s00535-008-2279-1

Cited by 66 publications

(62 citation statements)

References 31 publications

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“…In portal hypertension conditions, the intestinal recruitment of leucocytes is delayed, the local immune response may not be able to prevent the passage of bacteria from intestinal lumen to the systemic circulation, and mesenteric lymph nodes are deranged to retain and destroy bacteria [10][11][12]. The logical consequence is that endotoxin or bacterial DNA may easily reach the systemic circulation, causing liver endothelial dysfunction, imbalance of the intrahepatic circulation, worsening of portal hypertension, and hemodynamic complications, as those observed in studies on cirrhotics in normal conditions and post-prandial phase [13][14][15].…”

Section: Pathophysiologymentioning

confidence: 99%

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Zardi

Chin

et al. 2016

Journal of Cardiology

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Patients with advanced liver cirrhosis may develop a clinical syndrome characterized by a blunted contractile responsiveness to stress and/or altered diastolic relaxation, called "cirrhotic cardiomyopathy." This syndrome, which is initially asymptomatic, is often misdiagnosed due to the presence of symptoms that characterize other disorders present in patients with advanced liver cirrhosis, such as exercise intolerance, fatigue, and dyspnea. Stress and other conditions such as liver transplantation and transjugular intrahepatic portosystemic shunt (TIPS) may unmask this syndrome. Liver transplantation in this group of patients results in a clinical improvement and can be a cure for the cardiomyopathy. However, post-transplant prognosis depends on the identification of cirrhotics with cardiomyopathy in the pre-transplant phase; an early diagnosis of cirrhotic cardiomyopathy in the pre-transplant phase may avoid an acute onset or worsening of cardiac failure after liver transplantation. Since a preserved left ventricular ejection fraction may mask the presence of cirrhotic cardiomyopathy, the use of newer noninvasive diagnostic techniques (i.e. tissue Doppler, myocardial strain) is necessary to identify cirrhotics with this syndrome, in the pre-transplant phase. A pre-transplant treatment of heart failure in cirrhotics with cardiomyopathy improves the quality of life in this phase and reduces the complications during and immediately after liver transplantation. Since specific therapies for cirrhotic cardiomyopathy are lacking, due to the absence of a clear understanding of the pathophysiology of the cardiomyopathy, further research in this field is required.

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Section: Pathophysiologymentioning

confidence: 99%

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Zardi

Chin

et al. 2016

Journal of Cardiology

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“…3,4,5). After the Valsalva maneuver was discontinued, color flow mapping of the left renal veins became indistinct, reflecting decreased antegrade blood flow.…”

Section: Resultsmentioning

confidence: 96%

“…Spleno-renal shunt is one of the large spontaneous shunt paths that forms in the splenic hilum and is present in from nearly 14% to up to 21% of patients with hepatic cirrhosis [3]. Spleno-renal shunt is depicted on ultrasound as a blood vessel that meanders near the splenic hilum.…”

Section: Introductionmentioning

confidence: 99%

Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver

et al. 2010

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“…According to the guidelines of the European Society of Gastrointestinal Endoscopy [21], CE is currently the first-line imaging modality for diagnosing small-bowel lesions [22-24], especially for patients with OGIB. In addition, CE is usually preferred over DBE, as it is a safe and minimally invasive procedure, with the capsule being easy to swallow; yet its detection capabilities are extensive, such that small lesions, such as an angioectasia of the small bowel, can be diagnosed [25, 26]. We previously reported that CE has the potential to be used as a screening method to detect lesions related to PHT, as well as being effective for the diagnosis of EVs and PHG in patients with LC [2].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, PSs develop in an environment where the portal pressure is >10 mm Hg, acting as a bypass to compensate for PHT. Therefore, the presence of PSs indicates the severity of PHT and the exacerbation of EVs [26, 32]. …”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Portal Hypertensive Enteropathy Exacerbation in Patients with Liver Cirrhosis: A Capsule Endoscopy Study

et al. 2018

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Background/Aims: The clinical course and exacerbation of portal hypertensive enteropathy (PHE) are yet to be fully clarified. This study aimed to identify factors related to PHE exacerbation in patients with liver cirrhosis (LC). Methods: Fifty patients with LC (33 male; mean age, 67 years), who underwent capsule endoscopy (CE) at the Hiroshima University Hospital between February 2009 and September 2015, were followed up for >6 months. Exacerbation is defined as the appearance of new lesions or worsening of existing lesions. The association between PHE exacerbation and the clinical factors was evaluated. Results: PHE exacerbation was identified in 24 out of 50 (48%) of cases: erythema (14 cases); angioectasia (11 cases); erosions (9 cases); villous edema (8 cases); and esophageal varices (EVs; 6 cases). The following factors were significantly associated with PHE exacerbation: portosystemic shunts, EVs and portal hypertensive gastropathy (PHG) exacerbation. After therapy, CE findings among the 24 cases were as follows: villous edema (19 cases); erythema (17 cases); angioectasia (16 cases); erosions (12 cases); and EVs (9 cases), and no observable abnormalities in 2 cases. On multivariate analysis, exacerbation of EVs and PHG were independent predictors of PHE exacerbation. Conclusion: EVs and PHG exacerbation may predict PHE exacerbation in patients with LC.

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Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance

Abstract: The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.

Cited by 66 publications

References 31 publications

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase

Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver

Predictive Factors of Portal Hypertensive Enteropathy Exacerbation in Patients with Liver Cirrhosis: A Capsule Endoscopy Study

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