Abstract
In chronic liver disease management, the emergence of noninvasive tests, mainly transient elastography, to estimate liver fibrosis has resulted in a major impact in daily clinical practice, in the epidemiology of chronic liver disease, and it is challenging some of the current recommendations for liver cirrhosis. In this chapter, we will explain the importance of the use of TE in the management of severe chronic liver disease, we will also propose a new term to adequately describe these patients detected in the early phases of advanced chronic liver disease, and we will provide simple rules to avoid unnecessary procedures in such patients.
A new term of compensated advanced chronic liver disease (cACLD) defining patients in the early phases of severe chronic liver disease will be described, including both patients with severe fibrosis or pre-cirrhotic patients and patients with compensated cirrhosis. The term might be helpful for both clinical practice and research purposes. Simple clinical rules to avoid unnecessary endoscopies and hepatic venous pressure gradients in these cACLD patients will be also provided. With the combination of simple rules using liver stiffness measurement and platelet count, 40–45 % of screening endoscopies could be avoided in these patients, with an acceptable risk of missing varices. Similarly, using only liver stiffness a subgroup of cACLD patients can be safely considered as having clinically significant portal hypertension. These recommendations will definitely decrease the number of unneeded procedures in these patients.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bedossa P, Dargère D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457
Bedossa P, Carrat F (2009) Liver biopsy: the best, not the gold standard. J Hepatol 50:1–3
Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Gao H, Makuch R, Portal Hypertension Collaborative Group (2005) Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 353:2254–2261
Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS, Bosch J, Portal Hypertension Collaborative Group (2007) Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 133:481–8
de Franchis R (2000) Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 33:846–852
D’Amico G, Garcia-Tsao G, Pagliaro L (2006) Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 44:217–231
de Franchis R, Baveno V Faculty (2010) Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 53:762–768
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology (2007) Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 46:922–938
European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943
Castera L (2012) Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 142:1293–1302
Rudler M, Benosman H, Lebray P, Nghiem D, Ngo Y, Munteanu M, Poynard T, Thabut D (2011) Screening for esophageal varices in patients newly diagnosed in 2011: 84% of upper gastrointestinal endoscopies are futile. Hepatology 54(Suppl):935A (abstract)
Castera L (2011) Elastography in the non-invasive evaluation of the extent of fibrosis and in the diagnosis of portal hypertension. In: de Franchis R (ed) Proceedings of the fifth Baveno international consensus workshop. Wiley-Blackwell, Oxford, UK, pp 18–27
Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, Le Clesiau H, Beaugrand M (2011) Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 60:977–984
Koehler EM, Schouten JNL, Hansen BE, Stricker BH, Castera L, Janssen HLA (2012) Prevalence and risk factors of severe fibrosis in the elderly: transient elastography in a population-based study. Abstract book, Autumn meeting of the Dutch Society of Hepatology, Zeist, 4–5 Oct 2012. p 13
Wong VW, Chu WC, Wong GL, Chan RS, Chim AM, Ong A, Yeung DK, Yiu KK, Chu SH, Woo J, Chan FK, Chan HL (2012) Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography. Gut 61:409–415
Fung J, Lee CK, Chan M, Seto WK, Lai CL, Yuen MF, Hong Kong Liver Health Census Study Group (2015) High prevalence of non-alcoholic fatty liver disease in the Chinese – results from the Hong Kong liver health census. Liver Int 35:542–549
You SC, Kim KJ, Kim SU, Kim BK, Park JY, Kim do Y, Ahn SH, Lee WJ, Han KH (2015) Factors associated with significant liver fibrosis assessed using transient elastography in general population. World J Gastroenterol 21:1158–1166
Augustin S, Millán L, González A, Martell M, Gelabert A, Segarra A, Serres X, Esteban R, Genescà J (2014) Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study. J Hepatol 60:561–569
Chen T, Wong R, Wong P, Rollet-Kurhajec KC, Alshaalan R, Deschenes M, Ghali P, Sebastiani G (2015) Occult cirrhosis diagnosed by transient elastography is a frequent and under-monitored clinical entity. Liver Int. doi:10.1111/liv.12802 [Epub ahead of print]
Kim MN, Kim SU, Kim BK, Park JY, Kim DY, Ahn SH, Song KJ, Park YN, Han KH (2015) Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis. Hepatology. doi:10.1002/hep.27735 [Epub ahead of print]
Abraldes J, Bureau C, Stefanescu H, Augustin S, Ney M, Procopet B, Bosch J, Genesca J, Berzigotti A (2015) Non-invasive tools and risk of varices and clinically significant portal hypertension in compensated cirrhosis: the “ANTICIPATE” Study. J Hepatol 62(Suppl 2):S198–S199 (abstract)
Krogsgaard K, Gluud C, Henriksen JH, Christoffersen P (1984) Correlation between liver morphology and portal pressure in alcoholic liver disease. Hepatology 4:699–703
van Leeuwen DJ, Howe SC, Scheuer PJ, Sherlock S (1990) Portal hypertension in chronic hepatitis: relationship to morphological changes. Gut 31:339–343
Rinella ME, Sanyal AJ (2015) NAFLD in 2014: genetics, diagnostics and therapeutic advances in NAFLD. Nat Rev Gastroenterol Hepatol 12:65–66
Castera L, Pinzani M, Bosch J (2012) Non invasive evaluation of portal hypertension using transient elastography. J Hepatol 56:696–703
Shi KQ, Fan YC, Pan ZZ, Lin XF, Liu WY, Chen YP, Zheng MH (2013) Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int 33:62–71
Kim BK, Han KH, Park JY, Ahn SH, Kim JK, Paik YH, Lee KS, Chon CY, Kim do Y (2010) A liver stiffness measurement based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol 105:1382–1390
Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, Schiumerini R, Turco L, Di Biase AR, Mazzella G, Marzi L, Arena U, Pinzani M, Festi D (2012) Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology 143:646–654
Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, García-Pagán JC, Pinzani M, Bosch J (2013) Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology 144:102–111
Montes Ramirez ML, Pascual-Pareja JF, Sánchez-Conde M, Bernardino De la Serna JI, Zamora Vargas FX, Miralles P, Castro JM, Ramírez M, Gutierrez I, Gonzalez-García J, Berenguer J, Arribas López JR (2012) Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis. AIDS 26:1807–1812
Ding NS, Nguyen T, Iser DM, Hong T, Flanagan E, Wong A, Luiz L, Tan JY, Fulforth J, Holmes J, Ryan M, Bell SJ, Desmond PV, Roberts SK, Lubel J, Kemp W, Thompson AJ (2015) Liver stiffness plus platelet count can be used to exclude high risk oesophageal varices. Liver Int. doi:10.1111/liv.12916 [Epub ahead of print]
Kitson MT, Roberts SK, Colman JC, Paul E, Button P, Kemp W (2015) Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol 50:462–469
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this paper
Cite this paper
Augustin, S., Pons, M., Santos, B., Ventura, M., Genescà, J. (2016). Identifying Compensated Advanced Chronic Liver Disease: When (Not) to Start Screening for Varices and Clinically Significant Portal Hypertension. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-23018-4_5
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-23017-7
Online ISBN: 978-3-319-23018-4
eBook Packages: MedicineMedicine (R0)