Transient elastography is increasingly employed in clinical practice for the noninvasive detection of tissue fibrosis in patients with chronic liver disease, and particularly chronic hepatitis C virus-related hepatitis.
Dr Umbertho Arena from Italy provided a definitive characterization of the “confounding” increase in liver stiffness following a standardized meal in a consecutive population of 125 patients with chronic hepatitis C virus infection at different stages of fibrotic evolution.
Liver stiffness values were obtained after overnight fasting and 15, 30, 45, 60, and 120 minutes following the onset of a standardized liquid meal.
|There was an evident increase in liver stiffness values 15 to 45 minutes after the onset of the meal |
The team observed an evident increase in liver stiffness values 15 to 45 minutes after the onset of the meal with return to baseline premeal levels within 120 minutes in all patients.
The peak postmeal delta increase in liver stiffness was progressively more marked with increasing stages of fibrosis, becoming maximal in patients with cirrhosis.
However, the probability of identifying the Metavir stage of fibrosis, the Child-Pugh class, or the presence/absence of esophageal varices with the postmeal delta increase in liver stiffness was inferior to that obtained with baseline liver stiffness values.
Dr Arena's team, "The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of liver stiffness measurements for the prediction of fibrosis stage in patients with chronic hepatitis C virus, and suggest that a fasting period of 120 minutes should be observed before the performance of transient elastography."