S5396 Idiopathic Non-Cirrhotic Portal Hypertension in Long-Term Marijuana Users: A Case Series

Introduction: Non-cirrhotic portal hypertension (NCPH) is a rare condition characterized by elevated portal venous pressure in the absence of liver cirrhosis. Traditional risk factors include thrombosis, infections, and certain medications. However, recent anecdotal observations have suggested a possible association between chronic marijuana use and the development of NCPH, potentially linked to hepatic vascular effects of cannabinoids. This case series explores 4 cases of NCPH in patients with prolonged marijuana use, aiming to provide initial insights into this possible relationship. Case Description/Methods: Four non-obese patients (aged 35–58 years) with chronic marijuana use and without alcohol use disorder presented with symptoms of portal hypertension, including splenomegaly, esophageal varices, and ascites, without evidence of cirrhosis on imaging or biopsy. Patient 1 is a 42-year-old man with a 15-year history of daily marijuana use who presented with recurrent ascites and variceal bleeding. Imaging showed splenomegaly and portal vein dilation, while liver biopsy revealed no fibrosis. Patient 2 is a 58-year-old woman who reported using marijuana daily for over 20 years who was evaluated for fatigue, abdominal distension, and hematemesis. Endoscopy confirmed large esophageal varices, and elastography showed no fibrosis. Patient 3 is a 35-year-old man who reported using marijuana for 12 years and experienced recurrent ascites and hypersplenism. Ascitic fluid studies were consistent with portal hypertension, but liver biopsy was normal. Patient 4 is a 48-year-old man who reported using marijuana for over 25 years who developed symptoms of portal hypertension, including variceal bleeding. Despite portal vein enlargement on imaging, liver biopsy showed minimal architectural changes. Discussion: These cases highlight a potential link between chronic marijuana use and NCPH. The pathogenesis of NCPH in these patients remains unclear, but cannabinoids may induce vascular changes within the liver that contribute to portal hypertension. While chronic marijuana use has been associated with cardiovascular and gastrointestinal effects, data on hepatic vascular effects remains poor. Prior studies have documented the impact of cannabinoids on vascular tone and inflammation, raising questions about mechanisms by which prolonged marijuana use contributes to altered portal venous pressure. This case series proposes a novel association of chronic marijuana use and the development of NCPH. These cases underscore the need for further research into long-term hepatic vascular effects of marijuana.