Early portal hypertension in metabolic dysfunction-associated steatotic liver disease: a concise review.

Introduction: In the metabolic dysfunction-associated steatotic liver disease (MASLD) scenario, more and more evidence has emerged indicating that MASLD patients can develop portal hypertension (PH), which has a direct impact on the prognosis of the disease and represents a significant challenge during the clinical approach.

Areas covered: There are different explanations for early PH pathophysiology in patients with MASLD, among which are dysbiosis, microthrombosis, impairments in inflammatory mediators, sinusoid-level alterations in the liver architecture, genetic factors, and so on. Currently, we have evidence in animal models and humans demonstrating that all these factors could be modulated or modified; unfortunately, we are far from translating these results into clinical scenarios. The early PH phenomenon only occurs in 20% patients with MASLD. This review aims to describe the current evidence from the pathophysiological and treatment point of view, as well as the implications in the clinical care of patients with MASLD presenting early PH.

Expert opinion: Although the presence of PH in these patients has a significant clinical impact, the traditional diagnostic approach may not be the best option; other diagnostic tools have been studied, and perhaps, at some point, they can be added to the treatment algorithms of these patients.