Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2020; 12(1): 1-8
Published online Jan 27, 2020. doi: 10.4240/wjgs.v12.i1.1
Pathological abnormalities in splenic vasculature in non-cirrhotic portal hypertension: Its relevance in the management of portal hypertension
Shahana Gupta, Biju Pottakkat, Surendra Kumar Verma, Raja Kalayarasan, Sandip Chandrasekar A, Ajith Ananthakrishna Pillai
Shahana Gupta, Biju Pottakkat, Raja Kalayarasan, Sandip Chandrasekar A, Department of Surgical Gastroenterology, JIPMER, Pondicherry 605006, India
Surendra Kumar Verma, Department of Pathology, JIPMER, Pondicherry 605006, India
Ajith Ananthakrishna Pillai, Department of Cardiology, JIPMER, Pondicherry 605006, India
Author contributions: All authors have made substantial contributions to conception and design of study, acquisition, analysis and interpretation of data; They have contributed equally to drafting of the manuscript and made critical revisions related to important intellectual content of the manuscript; All authors have approved the final version of the manuscript.
Institutional review board statement: The study has been approved by Post graduate Research Committee (PGRMC) and Institute Ethics Committee (IEC) of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondycherry, India, an Institute of National Importance under Government Of India.
Conflict-of-interest statement: None of the authors have any conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Corresponding author: Biju Pottakkat, MD, Professor, Additional Professor and Head, Department of Surgical Gastroenterology, JIPMER, Super-speciality Block 4th Floor, Pondicherry 605006, India.
Received: August 5, 2019
Peer-review started: August 5, 2019
First decision: August 31, 2019
Revised: September 25, 2019
Accepted: November 7, 2019
Article in press: November 7, 2019
Published online: January 27, 2020
Core Tip

Core tip: Portal hypertensive vasculopathy is well-investigated in cirrhotics. Raised portal pressure and hyperdynamic circulation are thought to be the underlying cause. Pathological changes in the splenic vein are similar in cirrhotic and non-cirrhotic portal hypertension (NCPH). They are not primarily due to venous degenerative changes, and are similar to those observed in the pulmonary vasculature in pulmonary hypertension. Portal hypertension in NCPH should be viewed as a systemic and pulmonary hypertension equivalent in the gastrointestinal tract. We show that these pathological venous changes in NCPH are observed in a greater proportion of patients in the delayed presentation group (P < 0.003). Interventions to reduce portal pressure should therefore be initiated at diagnosis of NCPH. Damage to the vasculature starts early and can be prevented from progressing to venous thrombosis and its sequelae if early surgical intervention is initiated to reduce portal pressure.