Descriptive cohort of adult patients with portal hypertension at a tertiary care institution in Colombia

Authors

DOI:

https://doi.org/10.59093/27112330.106

Keywords:

portal hypertension, esophageal varices, liver cirrhosis, abdominal ultrasound, gastrointestinal bleeding, elastography.

Abstract

Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.

Downloads

Download data is not yet available.

Author Biographies

Christian Melgar-Burbano, Universidad de Antioquia, Universidad Surcolombiana

Médico, Especialista en Medicina Interna, Especialista en Gastroenterología, Fellow de Hepatología, Universidad de Antioquia. Medellín, Colombia. Docente, Universidad Surcolombiana. Neiva, Colombia.

María Paz González-Ovalle, Universidad de Antioquia

Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Ana María Muñoz-Restrepo, Universidad de Antioquia

Ingeniera Química, Estudiante de Medicina, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Lina María Leiva-Panqueva, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo

Médica, Especialista en Epidemiología, Residente de Medicina Interna. Grupo de investigación EPIMEDIC, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo. Neiva, Colombia.

David Camilo Izquierdo-Córdoba, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo

Médico General, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo. Neiva, Colombia.

Jennifer Nathalia Navia-Fernández, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo

Médica General, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo. Neiva, Colombia

Liam Maximiliano Pinto-Aguilera, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo

Médico General, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo. Neiva, Colombia.

References

Oliver TI, Sharma B, John S. Portal hypertension. Treasure Island (FL): StatPearls Publishing; 2023. Acceso 17 de junio de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK507718/.

Simonetto DA, Liu M, Kamath PS. Portal hypertension and related complications: Diagnosis and management. Mayo Clin Proc 2019;94:714-726. https://doi.org/10.1016/j.mayocp.2018.12.020.

Bloom S, Kemp W, Lubel J. Portal hypertension: pathophysiology, diagnosis and management. Intern Med J 2015;45:16-26. https://doi.org/10.1111/imj.12590.

Montaño-Loza A, Meza-Junco J. Patogénesis de la hipertensión portal. Rev Invest Clin 2005;57:596-607.

de Franchis R, Bosch J, García-Tsao G, Reiberger T, Ripoll C. Baveno VII-Renewing consensus in portal hypertension. J Hepatol 2022;76:959-974. https://doi.org/10.1016/j.jhep.2021.12.022.

Balducci G, Sterpetti AV, Ventura M. A short history of portal hypertension and of its management. J Gastroenterol Hepatol 2016;31:541-545. https://doi.org/10.1111/jgh.13200.

Bañares R, Yepes I. Estudio hemodinámico hepático. Rev Esp Enferm Dig 2012;104:497. https://dx.doi.org/10.4321/S1130-01082012000900010.

Zardi EM, Di Matteo FM, Pacella CM, Sanyal AJ. Invasive and non-invasive techniques for detecting portal hypertension and predicting variceal bleeding in cirrhosis: a review. Ann Med 2014;46:8-17. https://doi.org/10.3109/07853890.2013.857831.

Llop E, Seijo S. Actuación ante la trombosis portal no cirrótica no tumoral. Gastroenterol Hepatol 2016;39:403-410. https://doi.org/10.1016/j.gastrohep.2015.09.007.

Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019;156:1582-1599. https://doi.org/10.1053/j.gastro.2019.01.265.

Intagliata NM, Ferreira CN, Caldwell SH. Anticoagulación en la trombosis de la vena porta en la cirrosis. Clin Liver Dis (Hoboken) 2016;8:S10-15. https://doi.org/10.1002/cld.599.

Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World J Gastroenterol 2020;26:6111- 6140. https://doi.org/10.3748/wjg.v26.i40.6111.

Mauro E, Gadano A. What's new in portal hypertension? Liver Int 2020;40:S122-127. https://doi.org/10.1111/liv.14366.

Koh C, Heller T. Approach to the diagnosis of portal hypertension. Clin Liver Dis (Hoboken) 2012;1:133-135. https://doi.org/10.1002/cld.78

Muñoz-Maya O, Ferrusquía-Acosta J, Serna-Patiño LM, Cárdenas A. Métodos diagnósticos en hipertensión portal. Rev Colomb Gastroenterol 2021;36:218-226. https://doi.org/10.22516/25007440.692.

Wang C, Huang Y, Liu C, Liu F, Hu X, Kuang X, et al. Diagnosis of clinically significant portal hypertension using CT- and MRI-based vascular model. Radiology 2023;307:e221648. https://doi.org/10.1148/radiol.221648.

Al-Busafi SA, McNabb-Baltar J, Farag A, Hilzenrat N. Clinical manifestations of portal hypertension. Int J Hepatol 2012;2012:203794. https://doi.org/10.1155/2012/203794.

Yoo JJ, Kim SG. The rise of non-invasive tools in the diagnosis of portal hypertension: Validation of the Baveno VII consensus. Clin Mol Hepatol 2023;29:102-104. https://doi.org/10.3350/cmh.2022.0353.

Llop E, Calleja JL. Spleen stiffness: The "new kid on the block" in the diagnosis of clinical significant portal hypertension. J Clin Exp Hepatol 2023;13:385-386. https://doi.org/10.1016/j.jceh.2023.04.006.

Kim MY, Jeong WK, Baik SK. Invasive and non-invasive diagnosis of cirrhosis and portal hypertension. World J Gastroenterol 2014;20:4300-4315. https://doi.org/10.3748/wjg.v20.i15.4300.

Choi AY, Chang KJ. Endoscopic diagnosis of portal hypertension. Tech Innov Gastrointest Endosc 2022;24:167-175. https://doi.org/10.1016/j.tige.2022.01.003.

Sanyal AJ, Bosch J, Blei A, Arroyo V. Portal hypertension and its complications. Gastroenterology 2008;134:1715-1728. https://doi.org/10.1053/j.gastro.2008.03.007.

Arrieta O, Cacho B, Morales-Espinosa D, Ruelas-Villavicencio A, Flores-Estrada D, Hernández-Pedro N. The progressive elevation of alpha fetoprotein for the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis. BMC Cancer 2007;7:28. https://doi.org/10.1186/1471-2407-7-28.

Published

2024-01-02

How to Cite

Melgar-Burbano, C., González-Ovalle, M. P., Muñoz-Restrepo, A. M., Leiva-Panqueva, L. M., Izquierdo-Córdoba, D. C., Navia-Fernández, J. N., & Pinto-Aguilera, L. M. (2024). Descriptive cohort of adult patients with portal hypertension at a tertiary care institution in Colombia. Hepatología, 5(1), 87–96. https://doi.org/10.59093/27112330.106

Issue

Section

Original articles
QR Code
Crossref Cited-by logo