title: Prevalence and indicators of portal hypertension in patients with nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Little is known about the prevalence and severity of portal hypertension in patients with nonalcoholic fatty liver disease (NAFLD). We investigated the prevalence and noninvasive predictors of portal hypertension in patients with NAFLD.
  
  
  METHODS
  Signs of portal hypertension, including esophageal varices, splenomegaly, portosystemic encephalopathy, and ascites, were investigated in 354 patients with NAFLD.
  
  
  RESULTS
  One hundred patients had portal hypertension at the time of NAFLD diagnosis (28.2%), 88 of these patients had septal fibrosis or cirrhosis (88%). Fibrosis stage correlated with presence (r = 0.41, P < .0001) and number of findings (r = 0.48, P = .006) of portal hypertension. Of the 204 patients with no or mild fibrosis (stages, 0-2), 12 patients had portal hypertension (6%); they had a significantly higher grade of steatosis, based on biopsy analysis, compared with the 192 patients without portal hypertension (94%). Thrombocytopenia, hyperbilirubinemia, cirrhosis, and obesity were associated independently with portal hypertension. Esophageal varices were found in 57 of the 128 patients undergoing endoscopic screening (44.5%) and were associated independently with thrombocytopenia, type 2 diabetes, and splenomegaly.
  
  
  CONCLUSIONS
  Signs of portal hypertension were present in 25% of patients at the time of diagnosis of NAFLD; most had advanced fibrosis or cirrhosis. Portal hypertension can occur in a small proportion of patients with mild or no fibrosis and is associated with the extent of steatosis. Features of advanced liver disease and insulin resistance might identify patients with NAFLD and portal hypertension, and those expected to derive the most benefit from endoscopic screening for esophageal varices.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Flavia D
authors.initials: FD
authors.lastname: Mendes
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
authors.forename: Schuyler O
authors.initials: SO
authors.lastname: Sanderson
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lindor
authors.forename: Paul
authors.initials: P
authors.lastname: Angulo
mesh_terms: D000328:Adult; D001201:Ascites / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D013163:Splenomegaly / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology