Nonalcoholic fatty liver disease (NAFLD) and Portal Hypertension in Egyptian Patients

Title: Nonalcoholic fatty liver disease (NAFLD) and Portal Hypertension in Egyptian Patients

Authors: Mohsen M. Maher, M.D, Wesam A. Ibrahim, M.D, Shereen A. Saleh, M.D, Iman F Montasser, M.D, Ahmed Hussein, M.D, Khaled A Mansour, M.D, Moetaz Sayed, M.D, Omar Farouk, M.D, Kareem Abdel Nabi, Master’s Degree

DOI: http://dx.doi.org/10.18535/jmscr/v4i7.13

Abstract

Background and Study aims: Although nonalcoholic fatty liver disease (NAFLD) typically follows a benign non progressive clinical course, there is evidence that NAFLD even in the absence of liver fibrosis can induce portal hypertension which has serious sequelae such as splenomegaly, esophageal varices and as cites. The aim of this work is to assess the possibility of NAFLD to affect portal venous pressure in absence of fibrosis, and to correlate the severity of steatosis with the portalvein diameter. Patients and Methods: this study included eighty patients with NAFLD. All participants were subjected to detailed history taking, clinical examination, laboratory tests, abdominal ultrasound and portal vein duplex as well as liver biopsy to determine the histological degree of steatosis and to exclude liver fibrosis. Results: the patients were 50 males (62.5%) and 30 females (37.5%), their mean age was 30.08±11.70. The degree of steatosis according to liver biopsies ranged from 3%-20% with mean of (14.57 ± 5.74) and the portal vein diameter measured by portal vein duplex ranged from 10- 14mm with mean of (11.5 ± 1.24). There was statistically significant positive correlation between the degree of steatosis and portal vein diameter, spleen size, fasting blood sugar, total cholesterol, LDL, HDL and ALT. Conclusion: hepatic steatosis correlates with portal vein diameter and size of the spleen in the absence of fibrosis and can lead to portal hypertension.

Keywords: NAFLD; steatosis; portal hypertension; liver biopsy; spleen

References

1. Bacon BR, Farahvash MJ, Janney CG and Neuschwander-Tetri BA. "Nonalcohol-icsteato hepatitis: an expanded clinical entity". Gastroenterol.1994; 107:1103-9.

2. Chalasani N, Younossi Z, Lavine J, Diehl A, Brunt E, Cusi K, et al. "TheDiagnosis and Management of Non-Alcoholic Fatty Liver Disease: PracticeGuideline by the American Association for the Study of Liver Diseases, AmericanCollege of Gastroenterology, and the American Gastroenterological Association". Hepatol. 2012; 55: 2005-23.

3. Browning JD, Kumar KS, Saboorian MH and Thiele DL. "Ethnic differences in theprevalence of cryptogenic cirrhosis". Am J Gastroenterol. 2004; 99: 292-8.

4. Tilg H and Diehl AM. "Cytokines in alcoholic and nonalcoholic steatohepatitis". NEngl J Med. 2000; 343:1467-76.

5. Mendes FV, Suzuki A, Sanderson SO, Lindor KD, Angulo P. "Prevalence andindicators of portal hypertension in patients with nonalcoholic fatty liver disease". ClinGastroenterolHepatol. 2012; 10: 1028-33.

6. Khan A.N. and Cho KJ. "Portal Hypertension Imaging". Medscape (2013).

7. Benter T, Klühs L and Teichgräber U. "Sonography of the Spleen". J UltrasoundMed. 2011; 30:1281–93.

8. Allan R. "Ultrasound assessment of portal hypertension". Sound effects 2006; 1:22-7.

9. Nićiforović D, Till V, Lovrenski J, Govorcin M, Lucić Z, Lovrenski J. "DuplexDoppler sonography in portal hypertension". Med Pregl. 2007; 60: 161-7.

10. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW etal. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313-21.

11. Angulo P, Alba LM, Petrovic LM, Adams LA, Lindor KD, Jensen MD. "Leptin,insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease". J Hepatol.2004; 41:943-9

12. Adams LA, Sanderson S, Lindor KD, and Angulo P. "The histological course ofnonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liverbiopsies". J Hepatol. 2005; 30:145-53.

13. Cichoz-Lach H, Celinski K, Slomka M, and Kasztelan-Szczerbińska B."Pathophysiology of portal hypertension". J PhysiolPharmacol. 2008; 59:231-5.

14. Francque S, Wamutu S, Chatterjee S, Van Marck E, Herman A, Ramon A. "Nonalcoholicsteatohepatitis induces non-fibrosis-related portal hypertension associated withsplanchnic vasodilation and signs of a hyperdynamic circulation". Liver Int. 2010; 30:365-75.

15. Le BianAz, Costi R, Idrissi M and Smadja C. "Liver resection and metabolicdisorders: An undescribed mechanism leading to postoperative mortality". World JGastroenterol.2014; 20(39): 14455-62.

16. Suzuki K, kirikoshi H, Yoneda M, Mawatari H, Fujita K, Nozaki Y. "Measurementof spleen volume is useful for distinguishing between simple stestosis and early stage nonalcoholic steatohepatitis". Hepatology Research 2010; 40:693-700.

17. Colman JC, Britton RS, Orrego H, Saldivia V, Medline A, Israel Y. "Relationbetween nosmotically induced hepatocyte enlargement and portal hypertension". Am JPhysiol 1993; 245:G382-7.

18. Shi JP, XunYh, HU CB, Zhang L, Liu H, Lou GQ. "Clinical and histological feature of nonalcoholic fatty liver disease". chinese journal of hepatology 2009; 11:812-6.

19. Clark JM, Brancati FL and Diehl AM. "The prevalence and etiology of elevatedaminotransferase levels in the United States". Am J Gastroenterol.2003; 98:960-7.

20. Wang Z, Xu M, Peng J, Jiang L, Hu Z, Wang H, et al. "Prevalence and associatedmetabolic factors of fatty liver disease in the elderly". Exp Gerontol.2013; 48:705-9.

21. Lankarani KB, Ghaffarpasand K, Mahmoodi M, Lotfi M, Zamiri N, Heydari ST et al. "Non alcoholic fatty liver disease in southern Iran: A population based study". HepatMon. 2013; 13:e9248.

22. Fukuchi S, Hamaguchi K, Seike M, Himeno K, Sakata T, Yoshimatsu H. "Role ofFatty Acid Composition in the Development of Metabolic Disorders in Sucrose-Induced Obese Rats". ExpBiol Med. 2004; 229:486-93.

23. Khurram M and Ashraf MM. A clinical and biochemical profile of biopsy-provennon-alcoholic Fatty liver disease subjects. Journal of College of Physicians and Surgons Pakistan 2007; 17:531-4.

24. Taskinen MR, Adiels M, Westerbacka J, Söderlund S, Kahri J, Lundbom N et al. Dual metabolic defects are required to produce hyper triglyceridemia in obese subjects. ArteriosclerThrombVasc Biol.2011; 31:2144-50.

25. Kwak MS, Kim D, Chung GEKang SJ, Park MJ, Kim YJ, et al. Serum bilirubinlevels are inversely associated with non alcoholic fatty liver disease. ClinMolHepatol.2012; 18: 383-90.

26. Yu J, Chu ES, Wang R, Wang S, Wu CW, Wong VW, et al. Heme oxygenase-1protects against steatohepatitis in both cultured hepatocytes and mice. Gastroenterol.2010; 138:694-704.

27. Amarapurkar D, Kamani P, Patel N, et al (2007). Prevalence of non-alcoholicfatty liver disease: population based study. Ann Hepatol 2007; 6: 161–3.

28. Fan JG, Zhu J, Li XJ, Gupte P, Kumar P, Agal S, et al. "Prevalence of and riskfactors for fatty liver in a general population of Shanghai, China:. J Hepatol.2005; 43:508–14.

29. Chen ZW, Chen LY, Dai HL, Chen JH, Fang LZ. Relationship between alanineaminotransferase levels and metabolic syndrome in nonalcoholic fatty liver disease. J Zhejiang UnivSci B. 2008; 9: 616–22.

30. Farrell GC, McCullough AJ, Christopher P. Non-Alcoholic Fatty Liver Disease: A Practical Guide. Day John Wiley & Sons 2013. 328 pages.onlinelibrary.wiley. com/ doi/10.1002/9781118556153.ins/summa

Corresponding Author

Shereen A.Saleh, M.D

Internal Medicine Department, Faculty of Medicine, Ain Shams

University Hospital; El-Abbassia Square; Poatal Code: 11835; Cairo, Egypt

Tel.:+2001227834104, Fax: +20222626621. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.