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

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...

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Autores principales: Goel, Ashish, Ramakrishna, Banumathi, Zachariah, Uday, Sajith, K.G., Burad, Deepak K., Kodiatte, Thomas A., Keshava, Shyamkumar N., Balasubramanian, K.A., Elias, Elwyn, Eapen, C.E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676844/
https://www.ncbi.nlm.nih.gov/pubmed/31411170
http://dx.doi.org/10.4103/ijmr.IJMR_1405_17
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author Goel, Ashish
Ramakrishna, Banumathi
Zachariah, Uday
Sajith, K.G.
Burad, Deepak K.
Kodiatte, Thomas A.
Keshava, Shyamkumar N.
Balasubramanian, K.A.
Elias, Elwyn
Eapen, C.E.
author_facet Goel, Ashish
Ramakrishna, Banumathi
Zachariah, Uday
Sajith, K.G.
Burad, Deepak K.
Kodiatte, Thomas A.
Keshava, Shyamkumar N.
Balasubramanian, K.A.
Elias, Elwyn
Eapen, C.E.
author_sort Goel, Ashish
collection PubMed
description 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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spelling pubmed-66768442019-08-14 What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors Goel, Ashish Ramakrishna, Banumathi Zachariah, Uday Sajith, K.G. Burad, Deepak K. Kodiatte, Thomas A. Keshava, Shyamkumar N. Balasubramanian, K.A. Elias, Elwyn Eapen, C.E. Indian J Med Res Review Article 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'. Wolters Kluwer - Medknow 2019-04 /pmc/articles/PMC6676844/ /pubmed/31411170 http://dx.doi.org/10.4103/ijmr.IJMR_1405_17 Text en Copyright: © 2019 Indian Journal of Medical Research http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Goel, Ashish
Ramakrishna, Banumathi
Zachariah, Uday
Sajith, K.G.
Burad, Deepak K.
Kodiatte, Thomas A.
Keshava, Shyamkumar N.
Balasubramanian, K.A.
Elias, Elwyn
Eapen, C.E.
What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title_full What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title_fullStr What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title_full_unstemmed What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title_short What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors
title_sort what makes non-cirrhotic portal hypertension a common disease in india? analysis for environmental factors
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676844/
https://www.ncbi.nlm.nih.gov/pubmed/31411170
http://dx.doi.org/10.4103/ijmr.IJMR_1405_17
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