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Review
. 2022 Oct 28;10(5):979-985.
doi: 10.14218/JCTH.2021.00593. Epub 2022 Jul 19.

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Saut Horas H Nababan  1   2 , Cosmas Rinaldi Adithya Lesmana  1   2   3
Affiliations
Review

Portal Hypertension in Nonalcoholic Fatty Liver Disease: From Pathogenesis to Clinical Practice

Saut Horas H Nababan et al. J Clin Transl Hepatol. .

Abstract

Portal hypertension in nonalcoholic fatty liver disease (NAFLD) mostly occur in cirrhotic stage. However, several experimental and clinical studies showed evidence of portal hypertension in NAFLD without significant or advance fibrosis. This early development of portal hypertension in NAFLD is associated with liver sinusoidal contraction by hepatocellular lipid accumulation and ballooning, which is also accompanied by capillarization and dysfunction of liver sinusoidal endothelial cells. Both of these impaired mechanical and molecular components can cause an increase in intrahepatic vascular resistance which lead to the increase of portal pressure in the absence of significant liver fibrosis. Extrahepatic factors such as insulin resistance and gut dysbiosis may also contribute to liver sinusoidal endothelial dysfunction and early portal hypertension in NAFLD. The clinical impact of early portal hypertension in NAFLD is still unclear. However, clinical tools for diagnosis and monitoring of portal hypertension in NAFLD are being investigated to predict high-risk patients and to guide therapy.

Keywords: Metabolic; NAFLD; NASH; Portal hypertension.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. Theoretical framework of portal hypertension in NAFLD.
LSEC, liver sinusoidal endothelial cell; HSC, hepatic stellate cell; NAFLD, nonalcoholic fatty liver disease.
See this image and copyright information in PMC

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