Preprint / Version 1

What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors

Authors

  • Ashish Goel Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India
  • Elwyn Elias Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India
  • KA Balasubramanian Department of Wellcome Research Laboratory, Division of GI Sciences, Christian Medical College, Vellore, India
  • Shyamkumar Keshava Department of Radio-diagnosis, Division of GI Sciences, Christian Medical College, Vellore, India
  • Thomas Kodiatte Department of Pathology, Division of GI Sciences, Christian Medical College, Vellore, India
  • Deepak Burad Department of Pathology, Division of GI Sciences, Christian Medical College, Vellore, India
  • KG Sajith Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India
  • Uday Zachariah Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India
  • Banumathi Ramakrishna Department of Pathology, Division of GI Sciences, Christian Medical College, Vellore, India
  • CE Eapen Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India

Keywords:

Endothelial dysfunction, non-cirrhotic portal fibrosis, obliterative portal venopathy, poverty linked thrombophilia

Abstract

In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'. Keywords: Endothelial dysfunction, non-cirrhotic portal fibrosis, obliterative portal venopathy, poverty linked thrombophilia

Author Biography

Elwyn Elias, Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India

Department of Liver Unit, University Hospitals, Birmingham, UK

Downloads