Prevalence of histological features of idiopathic noncirrhotic portal hypertension in general population: a retrospective study of incidental liver biopsies

• Published in: Hepatology international Vol. 11; no. 5; pp. 452 - 460
• Main Authors: Zuo, Chunlai, Chumbalkar, Vaibhav, Ells, Peter F., Bonville, Daniel J., Lee, Hwajeong
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-09-2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Cirrhosis; Colorectal Surgery; Diagnosis; Drugs; Fatty liver; Female; Fibrosis; Hemorrhage; Hepatology; Humans; Hypertension; Hypertension, Portal - diagnosis; Hypertension, Portal - epidemiology; Hypertension, Portal - pathology; Liver; Liver cirrhosis; Liver Cirrhosis - pathology; Liver diseases; Male; Medicine; Medicine & Public Health; Middle Aged; New York - epidemiology; Original Article; Population studies; Prevalence; Retrospective Studies; Risk analysis; Risk factors; Septum; Surgery; Young Adult; Liver biopsy; Cholecystectomy; Idiopathic noncirrhotic portal hypertension (INCPH); Fatty liver; Elective procedure; Gastric bypass
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-017-9801-6

Background
Idiopathic noncirrhotic portal hypertension (INCPH) is associated with histologic changes secondary to obliterative portal venopathy without cirrhosis. We studied the prevalence of individual histological features of INCPH in liver biopsies obtained incidentally during unrelated elective procedures and in elective liver biopsies with the diagnosis of fatty liver disease.
Methods
A total of 53 incidental liver biopsies obtained intraoperatively during unrelated elective procedures and an additional 28 elective biopsies with the diagnosis of fatty liver disease without portal hypertension and cirrhosis were studied. Various histologic features of INCPH were evaluated.
Results
Shunt vessel (30%), phlebosclerosis (27%), increased number of portal vessels (19%) and incomplete septa (17%) were common in these liver biopsies after confounding factors such as co-existing fatty liver disease or fibrosis were excluded. At least one feature of INCPH was noted in 90% of the biopsies. Eight (10%) biopsies showed 5–6 features of INCPH. In total, 11 (14%) of 81 patients had risk factors associated with INCPH, including hypercoagulability, autoimmune disease, exposure to drugs, and infections. No patient had portal hypertension at the end of the follow-up.
Conclusion
The histologic features of INCPH are seen in incidental liver biopsies and fatty liver disease without portal hypertension. Ten percent of the biopsies show 5–6 features of INCPH without portal hypertension. Interpreting histologic features in the right clinical context is important for proper patient care.