title: Arsenicosis, possibly from contaminated groundwater, associated with noncirrhotic intrahepatic portal hypertension.
abstract: OBJECTIVE
  Idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH), a chronic microangiopathy of the liver caused by arsenicosis from use of contaminated groundwater, was reported from Asia. This study aimed to see, if in the twenty-first century, arsenicosis was present in NCIPH patients at our hospital and, if present, to look for groundwater contamination by arsenic in their residential locality.
  
  
  METHODS
  Twenty-seven liver biopsy proven NCIPH patients, 25 portal hypertensive controls with hepatitis B or C related cirrhosis and 25 healthy controls, matched for residential locality, were studied. Eighty-four percent to 96 % of study subjects belonged to middle or lower socioeconomic category. Arsenicosis was looked for by estimation of arsenic levels in finger/toe nails and by skin examination. Arsenic levels in nails and in ground water (in NCIPH patients with arsenicosis) was estimated by mass spectrometry.
  
  
  RESULTS
  Nail arsenic levels were raised in five (10 %) portal hypertensive study subjects [two NCIPH patients (both had skin arsenicosis) and three portal hypertensive controls]. All of these five patients were residents of West Bengal or Bangladesh. Skin arsenicosis was noted in three NCIPH patients (11 %) compared to none of disease/healthy controls. Ground water from residential locality of one NCIPH patient with arsenicosis (from Bangladesh) showed extremely high level of arsenic (79.5 μg/L).
  
  
  CONCLUSIONS
  Arsenicosis and microangiopathy of liver, possibly caused by environmental contamination continues in parts of Asia. Further studies are needed to understand the mechanisms of such 'poverty-linked thrombophilia'.
authors.affiliation: Department of Hepatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Clinical Biochemistry, Christian Medical College, Vellore, 632 004, India.
authors.forename: Pamela
authors.initials: P
authors.lastname: Christudoss
authors.affiliation: Department of Dermatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: Renu
authors.initials: R
authors.lastname: George
authors.affiliation: Department of Pathology, Christian Medical College, Vellore, 632 004, India.
authors.forename: Banumathi
authors.initials: B
authors.lastname: Ramakrishna
authors.affiliation: Wellcome Trust Research Laboratory, Christian Medical College, Vellore, 632 004, India.
authors.forename: G Jayakumar
authors.initials: GJ
authors.lastname: Amirtharaj
authors.affiliation: Department of Radiology, Christian Medical College, Vellore, 632 004, India.
authors.forename: Shyamkumar N
authors.initials: SN
authors.lastname: Keshava
authors.affiliation: Wellcome Trust Research Laboratory, Christian Medical College, Vellore, 632 004, India.
authors.forename: Anup
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Wellcome Trust Research Laboratory, Christian Medical College, Vellore, 632 004, India.
authors.forename: K A
authors.initials: KA
authors.lastname: Balasubramanian
authors.affiliation: Haemostasis Research Unit, Haematology Department, University College London, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Mackie
authors.affiliation: Department of Clinical Biochemistry, Christian Medical College, Vellore, 632 004, India.
authors.forename: Jude J
authors.initials: JJ
authors.lastname: Fleming
authors.affiliation: Department of Hepatology, Christian Medical College, Vellore, 632 004, India.|University Hospital Birmingham, Birmingham, UK.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Elias
authors.affiliation: Department of Hepatology, Christian Medical College, Vellore, 632 004, India. eapen@cmcvellore.ac.in.
authors.forename: Chundamannil E
authors.initials: CE
authors.lastname: Eapen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020261:Arsenic Poisoning / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D001152:Arsenicals / Q000009:adverse effects* / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D060587:Groundwater / Q000737:chemistry*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000378:metabolism; D007194:India; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000378:metabolism; D012867:Skin / Q000473:pathology; D014874:Water Pollutants, Chemical / Q000009:adverse effects* / Q000032:analysis; D014877:Water Pollution, Chemical / Q000009:adverse effects* / Q000032:analysis*; D055815:Young Adult
chemical_list: D001152:Arsenicals; D014874:Water Pollutants, Chemical
keywords: Endothelial activation; Liver; Microangiopathy; Noncirrhotic portal fibrosis