The porto‐hepatic spectrum of cirrhotic encephalopathy

It should be considered that portal hypertension per se has the ability of inducing by mechanotransduction an inflammatory response in the mesenteric venous system. This splanchnic endothelial inflammatory response related to the excessive mechanical energy can spread by a paracrine mechanism to an array of cells located in the subendothelial space. Of note, one of the cellular types that are increased in the above-mentioned subendothelial space in portal hypertension is the mast cell. Inflammatory splanchnic mast cells can stimulate the enteric nervous plexus as well as the autonomic nervous system. Through this afferent pathway this signal triggered by mechanotransduction can reach the Central Nervous System and consequently can induce an inflammatory neurological impairment. Therefore, it seems logical to propose that an additional etiopathogenic mechanism in the early development of hepatic encephalopathy could be the inflammatory response related to portal hypertension. This article is protected by copyright. All rights reserved.