Indian Journal of Gastroenterology

, Volume 35, Issue 3, pp 207–215 | Cite as

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

  • Ashish Goel
  • Pamela Christudoss
  • Renu George
  • Banumathi Ramakrishna
  • G. Jayakumar Amirtharaj
  • Shyamkumar N. Keshava
  • Anup Ramachandran
  • K. A. Balasubramanian
  • Ian Mackie
  • Jude J. Fleming
  • Elwyn Elias
  • Chundamannil E. EapenEmail author
Original Article


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.


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.


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).


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’.


Endothelial activation Liver Microangiopathy Noncirrhotic portal fibrosis 


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.

Compliance with ethical standards

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


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Copyright information

© Indian Society of Gastroenterology 2016

Authors and Affiliations

  • Ashish Goel
    • 1
  • Pamela Christudoss
    • 2
  • Renu George
    • 3
  • Banumathi Ramakrishna
    • 4
  • G. Jayakumar Amirtharaj
    • 5
  • Shyamkumar N. Keshava
    • 6
  • Anup Ramachandran
    • 5
  • K. A. Balasubramanian
    • 5
  • Ian Mackie
    • 7
  • Jude J. Fleming
    • 2
  • Elwyn Elias
    • 1
    • 8
  • Chundamannil E. Eapen
    • 1
    Email author
  1. 1.Department of HepatologyChristian Medical CollegeVelloreIndia
  2. 2.Department of Clinical BiochemistryChristian Medical CollegeVelloreIndia
  3. 3.Department of DermatologyChristian Medical CollegeVelloreIndia
  4. 4.Department of PathologyChristian Medical CollegeVelloreIndia
  5. 5.Wellcome Trust Research LaboratoryChristian Medical CollegeVelloreIndia
  6. 6.Department of RadiologyChristian Medical CollegeVelloreIndia
  7. 7.Haemostasis Research Unit, Haematology DepartmentUniversity College LondonLondonUK
  8. 8.University Hospital BirminghamBirminghamUK

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