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Protocol Details

Natural History of Noncirrhotic Portal Hypertension

This study is currently recruiting participants.

Summary | Eligibility | Citations | Contacts

Summary

Number

15-DK-0108

Sponsoring Institute

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Recruitment Detail

Type: Participants currently recruited/enrolled
Gender: Male & Female
Min Age: 12
Max Age: N/A

Referral Letter Required

No

Population Exclusion(s)

None

Special Instructions

Currently Not Provided

Keywords

Portal Hypertension;
Portal Fibrosis;
Liver Disease;
Varices;
Splenomegaly

Recruitment Keyword(s)

None

Condition(s)

Cystic Fibrosis;
Immunologic Deficiency Syndrome;
Turner Syndrome;
Congenital Hepatic Fibrosis;
Idiopathic Non-Cirrhotic Portal Hypertension

Investigational Drug(s)

None

Investigational Device(s)

None

Intervention(s)

None

Supporting Site

National Institute of Diabetes and Digestive and Kidney Diseases

Background:

- Noncirrhotic Portal Hypertension (NCPH) is caused by liver diseases that increase pressure in the blood vessels of the liver. It seems to start slowly and not have many warning signs. Many people may not even know that they have a liver disease. There are no specific treatments for NCPH.

Objectives:

- To learn more about how NCPH develops over time.

Eligibility:

- People age 12 and older who have NCPH or are at risk for getting it. In the past year, they cannot have had other types of liver disease that typically result in cirrhosis, liver cancer, or active substance abuse.

Design:

- Participants will have 2 screening visits.

- Visit 1: to see if they have or may develop NCPH.

- Medical history

- Physical exam

- Urine and stool studies

- Abdominal ultrasound

- Fibroscan. Sound waves measure liver stiffness.

<TAB>- Visit 2:

- Blood tests

- Abdominal MRI

- Echocardiogram

- Questionnaire

- Liver blood vessel pressure (hepatic venous portal gradient (HVPG)) measurement. This is done with a small tube inserted in a neck vein.

- They may have a liver biopsy.

- All participants will visit the clinic every 6 months for a history, physical exam, and blood tests. They will also repeat some of the screening tests yearly.

- Participants with NCPH will also have:

- Upper endoscopy test. A tube inserted in the mouth goes through the esophagus and stomach.

- At least every 2 years: Esophagogastroduodenoscopy.

- At least every 4 years: testing including HVPG measurements and liver biopsy.

- Participants without NCPH will also have:

- Liver biopsy and HVPG measurements to see if they have NCPH.

- Every 2 years: abdominal MRI and stool studies.

- The study will last indefinitely.

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Eligibility

INCLUSION CRITERIA:

-Age 12 years or above, male or female

-Known diagnosis of NCPH, or to be at the risk for NCPH by virtue of underlying disease processes such as but not limited to; CGD, SCD, Mastocytosis, CVID, CF, and CHF.

EXCLUSION CRITERIA:

-Evidence of other forms of liver disease that typically result in cirrhosis.

-Evidence of active chronic Hepatitis B infection as defined by the presence of hepatitis B surface antigen (HBsAg) in serum and elevated HBV DNA (>10,000 IU/mL).

-Hepatitis C as defined by the presence of hepatitis C RNA in serum.

-Primary sclerosing cholangitis as defined by liver histology.

-Primary biliary cirrhosis as defined by cholestasis, +/- antimitochondrial antibody positivity and liver histology.

-Wilson s disease as defined by ceruloplasmin below the limits of normal and liver histology and urinary copper consistent with Wilson disease.

-Autoimmune hepatitis as defined by antinuclear antibody (ANA) of 3 EU or greater and liver histology consistent with autoimmune hepatitis or previous response to immunosuppressive therapy for autoimmune hepatitis.

-Hemochromatosis as defined by presence of 3+ or 4+ stainable iron on liver biopsy or homozygosity for C282Y. Patients with iron saturation indices of >45% and serum ferritin levels of >300 ng/ml for men and >250 ng/ml for women will undergo genetic testing for hemochromatosis.

-Bile duct obstruction as suggested by imaging studies done within the previous six months.

-The presence of cirrhosis as demonstrated by liver biopsy.

-Active substance abuse, such as alcohol, inhaled or injection drugs within the previous one year (assessed during patient interviews by patient self-report).

-Evidence of hepatocellular carcinoma; either alpha-fetoprotein (AFP) levels greater than 50 ng/ml (normal <6.6ng/ml) and/or ultrasound (or other imaging study) demonstrating a mass suggestive of liver cancer.

-Evidence of Cholangiocarcinoma as suggested by liver histology.

-Any other severe condition, which in the opinion of the investigators would impede the patient s participation or compliance in the study.

-Inability to comply or give written informed consent.


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Citations:

Sarin SK, Aggarwal SR. Idiopathic portal hypertension. Digestion. 1998 Jul-Aug;59(4):420-3.

Sarin SK, Kumar A, Chawla YK, Baijal SS, Dhiman RK, Jafri W, Lesmana LA, Guha Mazumder D, Omata M, Qureshi H, Raza RM, Sahni P, Sakhuja P, Salih M, Santra A, Sharma BC, Sharma P, Shiha G, Sollano J; Members of the APASL Working Party on Portal Hypertension. Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment. Hepatol Int. 2007 Sep;1(3):398-413. doi: 10.1007/s12072-007-9010-9. Epub 2007 Sep 11.

Schouten JN, Garcia-Pagan JC, Valla DC, Janssen HL. Idiopathic noncirrhotic portal hypertension. Hepatology. 2011 Sep 2;54(3):1071-81. doi: 10.1002/hep.24422. Epub 2011 Jul 21.

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Contacts:

Principal Investigator

Referral Contact

For more information:

Theo Heller, M.D.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
BG 10 RM 10N248A
10 CENTER DR
BETHESDA MD 20814
(301) 402-7147
theoh@intra.niddk.nih.gov

Jaha F. Norman-Wheeler
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
BG 10-CRC RM 4-5722
10 CENTER DR
BETHESDA MD 20814
(301) 435-6122
jaha.norman-wheeler@nih.gov

Office of Patient Recruitment
National Institutes of Health Clinical Center (CC)
Building 61, 10 Cloister Court
Bethesda, Maryland 20892
Toll Free: 1-800-411-1222
Local Phone: 301-451-4383
TTY: 1-866-411-1010
PRPL@cc.nih.gov

Clinical Trials Number:

NCT02417740

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