Steatosis and portal hypertension

C. Puoti, L. Bellis

Department of Gastroenterology and Internal Medicine, Ospedale di Genzano – Rome (Italy)

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• Gastroenterology

Non Alcoholic Fatty Liver Disease (NAFLD) is characterized by histologically macrovesicular steatosis in the absence of alcohol consumption. Portal hypertension (PH) is a severe complication of liver cirrhosis leading to a higher risk to develop gastro-esophageal varices, ascites, hepatorenal syndrome, and hepatic encephalopathy. The definition of portal hypertension is based on a pressure measurement. It may be performed directly through portal vein punction or by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). The hepatic venous pressure gradient (HVPG) reflects the degree of PH in the majority of liver diseases. The hepatic vein catheterization with measurement of the HVPG is considered the golden standard for portal pressure evaluation. The mechanisms by which steatosis could induce PH are not fully understood. It is not clear whether the degree of PH differs between patients with viral and alcoholic cirrhosis, and between patients with mild vs severe steatosis, In the majority of the studies subjects with alcoholic cirrhosis were included. Among patients with NASH, the portal hypertensive syndrome appears only in those with advanced cirrhosis.
Further, although weight reduction decreases steatosis grade and fibrosis score, it is not clear whether it improves PH in patients with cirrhosis. In contrast, other studies found a correlation between the severity of steatosis and clinical or lab parameters of PH. We can conclude that up to now it is not actually clear whether steatosis in itself might affect portal pressure.