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World J Gastroenterol. Jan 28, 2024; 30(4): 290-307
Published online Jan 28, 2024. doi: 10.3748/wjg.v30.i4.290
Portal hypertension in patients with nonalcoholic fatty liver disease: Current knowledge and challenges
Anita Madir, Ivica Grgurevic, Emmanuel A Tsochatzis, Massimo Pinzani
Anita Madir, Ivica Grgurevic, Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb 10000, Croatia
Ivica Grgurevic, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Ivica Grgurevic, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb 10000, Croatia
Emmanuel A Tsochatzis, Massimo Pinzani, UCL Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London NW3 2PF, United Kingdom
Author contributions: All authors contributed to the conception and design of the study and acquisition, analysis and interpretation of the data; Madir A and Grgurevic I drafted the article; Tsochatzis EA and Pinzani M made critical revisions related to important intellectual content; and all the authors approved the final version of the manuscript.
Conflict-of-interest statement: Dr. Madir and Dr. Grgurevic have nothing to disclose. Dr. Tsochatzis reports personal fees from NovoNordisk, personal fees from Boehringer, personal fees from Pfizer, personal fees from Siemens, personal fees from NovoNordisk, personal fees from Echosens, personal fees from Abbvie, outside the submitted work. Dr. Pinzani reports personal fees from Chemomab (Israel); Takeda (USA); Astra Zeneca (UK); Dicerna (USA); Galecto (Sweden); Resolution Therapeutics (UK); Novo Nordisk (DK); Boehringer Ingelheim (Germany), personal fees from Engitix Therapeutics Ltd (UCL Spin-out) (UK), personal fees from Aculive Therapeutics Ltd (Cambridge University Spin-out) (UK), outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivica Grgurevic, DSc, FEBG, FRCP, MD, Professor, Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Gojko Susak Avenue 6, Zagreb 10000, Croatia. ivica.grgurevic@mef.hr
Received: October 5, 2023
Peer-review started: October 5, 2023
First decision: December 6, 2023
Revised: December 19, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: January 28, 2024
Processing time: 112 Days and 13.1 Hours
Core Tip

Core Tip: Portal hypertension (PH) occurs in patients with cirrhosis, but in non-alcoholic fatty liver disease (NAFLD) it is sometimes observed in non-cirrhotic stages due to perisinusoidal fibrosis and damage to liver microcirculation. The severity of PH tends to be underestimated by hepatic venous pressure gradient (HVPG) measurement in NAFLD, potentially due to the presence of pre-sinusoidal component, and some patients decompensate at HVPG < 10 mmHg. Liver elastography needs further validation in obese patients as it might overestimate the severity of PH. While candidate drugs for PH are currently in development, lifestyle changes and modulation of metabolic derangements remain the mainstay of treatment.