Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
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REVIEW ARTICLE
Year : 2019  |  Volume : 149  |  Issue : 4  |  Page : 468-478

What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors


1 Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India
2 Department of Pathology, Division of GI Sciences, Christian Medical College, Vellore, India
3 Department of Radio-diagnosis, Division of GI Sciences, Christian Medical College, Vellore, India
4 Department of Wellcome Research Laboratory, Division of GI Sciences, Christian Medical College, Vellore, India
5 Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India; Liver Unit, University Hospitals, Birmingham, UK

Correspondence Address:
Dr C E Eapen
Department of Hepatology, Christian Medical College, Vellore 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1405_17

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In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.


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