Is bacterial translocation involved in the pathogenesis of idiopathic Non Cirrhotic Intrahepatic Portal Hypertension?

Alagammai, PL (2013) Is bacterial translocation involved in the pathogenesis of idiopathic Non Cirrhotic Intrahepatic Portal Hypertension? Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Non cirrhotic intrahepatic portal hypertension (NCIPH) is traditionally named as non cirrhotic portal fibrosis (NCPF) in India. It is more prevalent in developing countries and it is a commonly encountered clinical entity. As per data from our centre, cryptogenic cirrhosis is the commonest cause for portal hypertension, 39 to 48% of patients labeled as cryptogenic cirrhosis turn out to be NCIPH after liver biopsy. NCIPH usually appears to have a benign course, however patients may worsen to a stage requiring liver transplantation. The exact etiopathogenesis of this common condition is still unknown. There are various hypotheses like infective, immunogenic, prothrombotic and trace elements exposure. There are data to support the association between gut disorders, prothrombotic conditions and NCIPH. Eapen et al found 16% of NCIPH patients to have celiac disease and 3% to have ulcerative colitis. Hillaire et al found association between prothrombotic conditions like myeloproliferative disorders and NCIPH. Considering the above associations, we postulate a hypothesis that a combined effect of gut disorders and prothrombotic conditions lead to portal microangiopathy. Gut disorders like celiac disease are commonly associated with altered intestinal permeability called as leaky gut. This leakiness can lead to migration of bacteria and bacterial products from the gut which is termed as bacterial translocation. In the presence of a preexisting prothrombotic state in portal circulation, these gut factors could trigger a thrombotic event. It is well known that in liver cirrhosis, altered intestinal permeability and bacterial translocation happen, particularly in patients with ascites and advanced cirrhosis. AIM : 1. To study the association between gut disorders, bacterial translocation and NCIPH. 2. To assess the status of ADAMTS13 (a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13) in NCIPH patients and compare with that of controls. CONCLUSIONS : Most of the NCIPH patients had shrunken liver by imaging and almost half of them had a high HVPG suggesting that liver biopsy is essential to differentiate NCIPH from cryptogenic cirrhosis. Prevalence of celiac disease among NCIPH patients was noted to be 9.4% which is much higher than that reported among general population (upto 1%) Intestinal permeability was preserved in majority of patients both among cases and controls There was no rise in plasma TNF alpha levels both in cases and controls ADAMTS13 activity was found to be significantly low in NCIPH patients than in Controls ADAMTS13 antigen level was found to be significantly low in NCIPH patients than in controls Among patients with compensated liver disease (CTP A status) there was a significantly low ADAMTS13 activity and antigen level among NCIPH patients in comparison with controls. There was no correlation between ADAMTS13 activity and MELD score or HVPG.

Item Type: Thesis (Masters)
Uncontrolled Keywords: bacterial translocation ; pathogenesis ; idiopathic ; Non Cirrhotic ; Intrahepatic Portal ; Hypertension?.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 05:21
Last Modified: 14 Jul 2017 05:21

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