Clinical

Liver stiffness tied to portal hypertension in cirrhosis

Last Updated: 2007-05-15 16:04:17 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Liver stiffness is indicative of portal hypertension in patients with hepatitis C virus (HCV)-related cirrhosis, Italian researchers report in the May issue of Hepatology

"Measurement of liver stiffness by transient elastography," senior investigator Dr. Massimo Pinzani told Reuters Health, "is a rapid and non-invasive system able to identify cirrhotic patients with clinically significant and severe portal hypertension."

These are patients, he added, "urgently needing further investigation and particularly upper GI endoscopy for the detection of esophageal varices."

Dr. Pinzani of the University of Florence and colleagues evaluated the ability of transient elastography to predict portal hypertension in 61 patients with HCV-related chronic liver disease. Transient elastography is based on measurement of the velocity of an acoustic shear wave induced in liver tissue, which is directly related to liver stiffness.

A strong relationship was found between liver stiffness and hepatic venous pressure gradient (HVPG), a standard method for the assessment of portal pressure.

However, the excellent correlation observed at HVPG values below 10 or 12 mm Hg was not seen at values at or above these levels. In addition, liver stiffness measurement positively correlated with the presence of esophageal varices, although no correlation with their size was apparent.

Transient elastography, using the FibroScan (Echosens) device, continued Dr. Pinzani, "can be performed in outpatient clinics, requires a very short training, and is characterized by very low intra- and inter-observer variability."

In an accompanying editorial, Drs. Joseph K. Lim and Roberto J. Groszmann of Yale University School of Medicine, New Haven, Connecticut note this is one of a number of new and promising approaches.

However, they also say that "the data supporting its role in evaluating the consequences of portal hypertension remain unconvincing. Additional data in carefully designed studies will help define its appropriate role in clinical practice."

Hepatology 2007;45:1290-1297.