Skip to main content

Advertisement

Log in

Arsenicosis, possibly from contaminated groundwater, associated with noncirrhotic intrahepatic portal hypertension

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

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’.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goel A, Madhu K, Zachariah U, et al. A study of aetiology of portal hypertension in adults (including the elderly) at a tertiary centre in southern India. Indian J Med Res. 2013;137:922–7.

    PubMed  PubMed Central  Google Scholar 

  2. Madhu K, Avinash B, Ramakrishna B, et al. Idiopathic non-cirrhotic intrahepatic portal hypertension: common cause of cryptogenic intrahepatic portal hypertension in a Southern Indian tertiary hospital. Indian J Gastroenterol. 2009;28:83–7.

    Article  PubMed  Google Scholar 

  3. Okuda K. Non-cirrhotic portal hypertension: why is it so common in India? J Gastroenterol Hepatol. 2002;17:1–5.

    Article  PubMed  Google Scholar 

  4. Chawla Y, Duseja A. Non-cirrhotic portal fibrosis (NCPF) is a vanishing disease in India. Trop Gastroenterol. 2003;24:45–6.

    PubMed  Google Scholar 

  5. Sarin SK, Kumar A, Chawla YK, et al. Non-cirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment. Hepatol Int. 2007;1:398–413.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schouten JN, Garcia-Pagan JC, Valla DC, Janssen HL. Idiopathic noncirrhotic portal hypertension. Hepatology. 2011;54:1071–81.

    Article  PubMed  Google Scholar 

  7. Goel A, Elias JE, Eapen CE, Ramakrishna B, Elias E. Idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH)—newer insights into pathogenesis and emerging newer treatment options. J Clin Exp Hepatol. 2014;4:247–56.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Maiwall R, Goel A, Pulimood AB, et al. Investigation into celiac disease in Indian patients with portal hypertension. Indian J Gastroenterol. 2014;33:517–23.

    Article  PubMed  Google Scholar 

  9. Eapen CE, Nightingale P, Hubscher SG, et al. Non-cirrhotic intrahepatic portal hypertension: associated gut diseases and prognostic factors. Dig Dis Sci. 2011;56:227–35.

    Article  CAS  PubMed  Google Scholar 

  10. Goel A, Alagammai PL, Nair SC, et al. ADAMTS13 deficiency, despite well-compensated liver functions in patients with noncirrhotic portal hypertension. Indian J Gastroenterol. 2014;33:355–63.

    Article  PubMed  Google Scholar 

  11. Mackie I, Eapen CE, Neil D, et al. Idiopathic noncirrhotic intrahepatic portal hypertension is associated with sustained ADAMTS13 deficiency. Dig Dis Sci. 2011;56:2456–65.

    Article  CAS  PubMed  Google Scholar 

  12. Das D, Chatterjee A, Mandal BK, Samanta G, Chakraborti D, Chanda B. Arsenic in ground water in six districts of West Bengal, India: the biggest arsenic calamity in the world. Part 2. Arsenic concentration in drinking water, hair, nails, urine, skin-scale and liver tissue (biopsy) of the affected people. Analyst. 1995;120:917–24.

    Article  CAS  PubMed  Google Scholar 

  13. Santra A, Das Gupta J, De BK, Roy B, Guha Mazumder DN. Hepatic manifestations in chronic arsenic toxicity. Indian J Gastroenterol. 1999;18:152–5.

    CAS  PubMed  Google Scholar 

  14. Datta DV. Letter: arsenic and non-cirrhotic portal hypertension. Lancet. 1976;1:433.

    Article  CAS  PubMed  Google Scholar 

  15. Datta DV, Mitra SK, Chhuttani PN, Chakravarti RN. Chronic oral arsenic intoxication as a possible aetiological factor in idiopathic portal hypertension (non-cirrhotic portal fibrosis) in India. Gut. 1979;20:378–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Guha Mazumder DN, Chakraborty AK, Ghose A, et al. Chronic arsenic toxicity from drinking tube well water in rural West Bengal. Bull World Health Organ. 1988;66:499–506.

    CAS  PubMed  Google Scholar 

  17. Sarin SK, Sharma G, Banerjee S, Kathayat R, Malhotra V. Hepatic fibrogenesis using chronic arsenic ingestion: studies in a murine model. Indian J Exp Biol. 1999;37:147–51.

    CAS  PubMed  Google Scholar 

  18. Nevens F, Fevery J, Van Steenbergen W, Sciot R, Desmet V, De Groote J. Arsenic and non-cirrhotic portal hypertension. A report of eight cases. J Hepatol. 1990;11:80–5.

    Article  CAS  PubMed  Google Scholar 

  19. Morris JS, Schmid M, Newman S, Scheuer PJ, Sherlock S. Arsenic and noncirrhotic portal hypertension. Gastroenterology. 1974;66:86–94.

    CAS  PubMed  Google Scholar 

  20. Huet PM, Guillaume E, Cote J, Légaré A, Lavoie P, Viallet A. Noncirrhotic presinusoidal portal hypertension associated with chronic arsenical intoxication. Gastroenterology. 1975;68:1270–7.

    CAS  PubMed  Google Scholar 

  21. Hillaire S, Bonte E, Denninger MH, et al. Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients. Gut. 2002;51:275–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Toniutto P, Fabris C, Bitetto D, et al. Role of AST to platelet ratio index in the detection of liver fibrosis in patients with recurrent hepatitis C after liver transplantation. J Gastroenterol Hepatol. 2007;22:1904–8.

    Article  PubMed  Google Scholar 

  23. Patro BK, Jeyashree K, Gupta PK. Kuppuswamy’s socioeconomic status scale 2010—the need for periodic revision. Indian J Pediatr. 2012;79:395–6.

    Article  PubMed  Google Scholar 

  24. Labour Bureau Statistics: Labour Bureau, Government of India. http://labourbureau.nic.in/indtab.html. Accessed on 15th May 2015.

  25. Samanta G, Sharma R, Roychowdhury T, Chakraborti D. Arsenic and other elements in hair, nails, and skin-scales of arsenic victims in West Bengal India. Sci Total Environ. 2004;326:33–47.

    Article  CAS  PubMed  Google Scholar 

  26. WHO. A field guide for detection, management and surveillance of arsenicosis cases. In: Caussy D, editors. Technical Publication No 30. New Delhi: WHO, SEARO; 2005. p. 11.

  27. Gerritsen HE, Turecek PL, Schwarz HP, Lammle B, Furlan M. Assay of von Willebrand factor (vWF)-cleaving protease based on decreased collagen binding affinity of degraded vWF: a tool for the diagnosis of thrombotic thrombocytopenic purpura (TTP). Thromb Haemost. 1999;82:1386–9.

    CAS  PubMed  Google Scholar 

  28. Yarranton H, Lawrie AS, Mackie IJ, Pinkoski L, Corash L, Machin SJ. Coagulation factor levels in cryosupernatant prepared from plasma treated with amotosalen hydrochloride (S-59) and ultraviolet A light. Transfusion. 2005;45:1453–8.

    Article  CAS  PubMed  Google Scholar 

  29. Nakanuma Y, Hoso M, Sasaki M, et al. Histopathology of the liver in non-cirrhotic portal hypertension of unknown aetiology. Histopathology. 1996;28:195–204.

    Article  CAS  PubMed  Google Scholar 

  30. Santra A, Maiti A, Das S, Lahiri S, Charkaborty SK, Mazumder DN. Hepatic damage caused by chronic arsenic toxicity in experimental animals. J Toxicol Clin Toxicol. 2000;38:395–405.

    Article  CAS  PubMed  Google Scholar 

  31. Das S, Santra A, Lahiri S, Guha Mazumder DN. Implication of oxidative stress and hepatic cytokine (TNF-a and IL-6) response in the pathogenesis of hepatic collagenesis in chronic arsenic toxicity. Toxicol Appl Pharmacol. 2005;204:18–26.

    Article  CAS  PubMed  Google Scholar 

  32. Santra A, Chowdhury A, Ghatak S, Biswas A, Dhali GK. Arsenic induces apoptosis in mouse liver is mitochondria dependent and is abrogated by N-acetylcysteine. Toxicol Appl Pharmacol. 2007;220:146–55.

    Article  CAS  PubMed  Google Scholar 

  33. Ghatak S, Biswas A, Dhali GK, Chowdhury A, Boyer JL, Santra A. Oxidative stress and hepatic stellate cell activation are key events in arsenic induced liver fibrosis in mice. Toxicol Appl Pharmacol. 2011;251:59–69.

    Article  CAS  PubMed  Google Scholar 

  34. Kao YH, Yu CL, Chang LW, Yu HS. Low concentrations of arsenic induce vascular endothelial growth factor and nitric oxide release and stimulate angiogenesis in vitro. Chem Res Toxicol. 2003;16:460–8.

    Article  CAS  PubMed  Google Scholar 

  35. Straub AC, Stolz DB, Ross MA, et al. Arsenic stimulates sinusoidal endothelial cell capillarization and vessel remodelling in mouse liver. Hepatology. 2007;45:205–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wanless IR, Wong F, Blendis LM, Greig P, Heathcote EJ, Levy G. Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension. Hepatology. 1995;21:1238–47.

    CAS  PubMed  Google Scholar 

  37. Ratnaike RN. Acute and chronic arsenic toxicity. Postgrad Med J. 2003;79:391–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kumar G, Gupta YK. Monitoring of mercury, arsenic, cadmium and lead in Ayurvedic formulations marketed in Delhi by flame AAS and confirmation by ICP-MS. Food Addit Contam Part B Surveill. 2012;5:140–4.

    Article  CAS  PubMed  Google Scholar 

  39. Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300:915–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Polizzotto ML, Kocar BD, Benner SG, Sampson M, Fendorf S. Near-surface wetland sediments as a source of arsenic release to ground water in Asia. Nature. 2008;454:505–8.

    Article  CAS  PubMed  Google Scholar 

  41. Srivastava KK, Chattopadhyay AK, Mehta BC. Technology options for utilisation of arsenic contaminated ground water. Bhu-Jal News (Central Ground Water Board, Ministry of Water Resources, Govt. Of India) 2009; Vol 24; 119. http://www.cgwb.gov.in/documents/Bhujal_News_24_2.pdf (accessed on 2nd May, 2015).

  42. Ghosh NC, Singh RD. Groundwater arsenic contamination in India—vulnerability and scope for remedy. Central Ground Water Board, Ministry of Water Resources, Govt. Of India. http://www.cgwb.gov.in/documents/papers/incidpapers/Paper %208 %20- %20Ghosh.pdf (accessed on 2nd May 2015).

  43. Ministry of Water Resources, River Development & Ganga Rejuvenation, Government of India. National Mission for Clean Ganga. https://nmcg.nic.in/index.aspx (accessed on 16th June 2015).

  44. Goel A, Ramakrishna B, Muliyil J, et al. Use of serum vitamin B12 level as a marker to differentiate idiopathic noncirrhotic intrahepatic portal hypertension from cryptogenic cirrhosis. Dig Dis Sci. 2013;58:179–87.

    CAS  PubMed  Google Scholar 

Download references

Financial support

We gratefully acknowledge funds received from Department of Science and Technology, Government of India (EMR/2015/000570) and fluid research funds, Christian Medical College, Vellore, India towards conduct of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chundamannil E. Eapen.

Ethics declarations

Conflict of interest

AG, PC, RG, BR, GJA, SNK, AR, KAB, IM, JJF, EE, and CEE declare that they have no conflicts of interest.

Ethics statement

The study was performed in a manner that conforms with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goel, A., Christudoss, P., George, R. et al. Arsenicosis, possibly from contaminated groundwater, associated with noncirrhotic intrahepatic portal hypertension. Indian J Gastroenterol 35, 207–215 (2016). https://doi.org/10.1007/s12664-016-0660-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-016-0660-1

Keywords

Navigation