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Portal hypertension, esophageal varices common in patients with NAFLD

Patients with nonalcoholic fatty liver disease often had indications of portal hypertension and esophageal varices, most commonly among those with advanced fibrosis, in a recent study.

Researchers evaluated signs of portal hypertension in 354 patients with nonalcoholic fatty liver disease (NAFLD), including esophageal varices, splenomegaly, portosystemic encephalopathy and ascites. Medical histories were taken and physical examinations were performed on each patient, along with abdominal ultrasonography and/or CT scans and percutaneous liver biopsies. Endoscopy screenings for esophageal varices also were performed on 128 participants.

Portal hypertension was present in 100 (28.2%) participants at NAFLD diagnosis. Among them, 88% had cirrhosis or septal fibrosis, and investigators observed associations between fibrosis stage and the presence (P<.0001) and number of incidents (P=.006) of portal hypertension. Twelve patients out of 204 with mild or no fibrosis also had portal hypertension.

Independent associations were observed between portal hypertension and obesity (OR=2.5, 1.1-6.2), cirrhosis (OR=8.4, 3.9-18.4), hyperbilirubinemia (OR=7.6, 3.5-17.2) and thrombocytopenia (OR=8.1, 3.8-17.8) via multivariate analysis. When cirrhosis was removed from the model, diabetes (OR=3.0, 1.5-6.2) and hypoalbuminemia (OR=3.9, 1.6-9.7) also were associated with portal hypertension, along with thrombocytopenia (OR=16.9, 8.5-35.1) and hyperbilirubinemia (OR=5.6, 2.7-12.0) (95% CI for all).

Among patients who received endoscopic screening, 57 had esophageal varices. Multivariate analysis indicated independent associations with splenomegaly (OR=5.0, 1.4-19.5), type 2 diabetes (OR=5.1, 1.5-18.3) and thrombocytopenia (OR=16.8, 5.0-66.4) (95% CI for all).

“Portal hypertension and esophageal varices in our patients with NAFLD were common findings at the time the diagnostic liver biopsy was performed,” the researchers wrote. “Besides features indicative of more advanced liver disease, comorbid conditions indicative of more severe insulin resistance, such as type 2 diabetes and obesity, were important indicators of the presence of portal hypertension and esophageal varices. These clinical indicators may allow identification of patients with NAFLD with portal hypertension, and those who are expected to benefit the most from endoscopic screening for esophageal varices.”