Performance of Non-Invasive Liver Function Tests and Abdominal Ultrasound in the Prediction of Esophageal Varices

By 2020, chronic liver disease will have eclipsed ischaemic heart disease as the leading cause of working life years lost in the UK. As mortality from chronic liver disease continues to rise, the landscape of aetiology has shifted from infectious to non-communicable causes. In parallel with the growing prevalence of obesity and type 2 diabetes, non-alcoholic fatty liver disease is estimated to affect 25% of the UK adult population. Simultaneously, escalating alcohol consumption has fuelled public health and economic concerns regarding its widespread impact on working-age adults. Given that chronic liver disease remains clinically silent until its advanced stages, there is an urgent unmet need to identify affected individuals earlier in the disease process, enabling targeted intervention strategies which may improve prognosis. Robust epidemiological data have shown that liver fibrosis is the strongest predictor of clinically meaningful outcomes, including decompensation, liver cancer and overall mortality. Detecting fibrosis among at-risk individuals, in a manner that is reproducible, non-invasive, safe and cost effective, has become a major challenge of our time. This article addresses the pitfalls of the standard panel of liver function tests, discusses other non-invasive biomarkers and reviews imaging technologies which may revolutionise community-based diagnosis and stratification of chronic liver disease.

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Non-invasive cryolipolysis™ for subcutaneous fat reduction does not affect serum lipid levels or liver function tests

Lasers in Surgery and Medicine ◽

10.1002/lsm.20850 ◽

2009 ◽

Vol 41 (10) ◽

pp. 785-790 ◽

Cited By ~ 69

Author(s):

Kenneth B. Klein ◽

Brian Zelickson ◽

Jeffrey G. Riopelle ◽

Eric Okamoto ◽

Eric P. Bachelor ◽

...

Keyword(s):

Liver Function ◽

Serum Lipid ◽

Subcutaneous Fat ◽

Liver Function Tests ◽

Lipid Levels ◽

Non Invasive ◽

Serum Lipid Levels ◽

Function Tests ◽

Fat Reduction

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Role of the Standard ‘Liver Function Tests’ in Current Clinical Practice

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456328902600601 ◽

1989 ◽

Vol 26 (6) ◽

pp. 463-471 ◽

Cited By ~ 11

Author(s):

P J Johnson

Keyword(s):

Liver Function ◽

Liver Diseases ◽

Liver Function Tests ◽

Current Therapy ◽

Main Role ◽

Non Invasive ◽

Function Tests ◽

Precise Diagnosis ◽

Near Future

A prerequisite of current therapy in liver disease is precise diagnosis. The rapid increase in the number of tests available—immunological, virological, histological and radiological—testifies to this, and reflects the inadequacy of the ‘standard’ liver function tests (LFTs). The LFTs are, however, in contrast to these more sophisticated tests, observer independent and despite their lack of specificity, several characteristic patterns of abnormality can be recognised which direct the physician to the most appropriate definitive investigation. The cheapness and non-invasive nature of the LFTs makes them particularly appropriate for monitoring the course of liver diseases once the diagnosis has been established and this, together with screening for hepatotoxicity of newly developed drugs, is now their main role. A second generation of liver function tests based on the capacity of the liver to eliminate various test compounds may come closer to offering a true estimate of liver function. More accurate methods of measuring the various bilirubin fractions, particularly bilirubin conjugates may also become available in the near future and provide more sensitive tests of liver dysfunction.

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A young man with bleeding esophageal varices

Thai Journal of Hepatology ◽

10.30856/th.jhep2018vol1iss1_65 ◽

2018 ◽

Vol 1 (1) ◽

pp. 14-16

Author(s):

Soonthorn Chonprasertsuk

Keyword(s):

Risk Factors ◽

Portal Hypertension ◽

Liver Function ◽

Physical Examination ◽

Esophageal Varices ◽

Liver Function Tests ◽

Noncirrhotic Portal Hypertension ◽

Liver Histopathology ◽

Function Tests ◽

Bleeding Esophageal Varices

The noncirrhotic portal hypertension is an uncommon cause of bleeding esophageal varices. This condition must be suspected in patients with preserved liver function. We report a 25-year old man with SLE disease who presented with hematemesis. He had no history or risk factors for an underlying liver condition. A huge splenomegaly was detected by physical examination. The EGD found three large varices with red wale sign, whereas liver function tests were unremarkable. The noncirrhotic portal hypertension was diagnosed and confirmed by liver histopathology.

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A young man with bleeding esophageal varices

Thai Journal of Hepatology ◽

10.30856/th.jhep2018vol1iss1_02 ◽

2018 ◽

Vol 1 (1) ◽

pp. 14-16

Author(s):

Soonthorn Chonprasertsuk

Keyword(s):

Risk Factors ◽

Portal Hypertension ◽

Liver Function ◽

Physical Examination ◽

Esophageal Varices ◽

Liver Function Tests ◽

Noncirrhotic Portal Hypertension ◽

Liver Histopathology ◽

Function Tests ◽

Bleeding Esophageal Varices

The noncirrhotic portal hypertension is an uncommon cause of bleeding esophageal varices. This condition must be suspected in patients with preserved liver function. We report a 25-year old man with SLE disease who presented with hematemesis. He had no history or risk factors for an underlying liver condition. A huge splenomegaly was detected by physical examination. The EGD found three large varices with red wale sign, whereas liver function tests were unremarkable. The noncirrhotic portal hypertension was diagnosed and confirmed by liver histopathology. Figure 1 แสดงผลการส่องกล้องทางเดินอาหารส่วนบน พบ F3 varices with red wale sign

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Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

Nutrients ◽

10.3390/nu12051217 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1217

Author(s):

Elisabeth Blüthner ◽

Ulrich-Frank Pape ◽

Martin Stockmann ◽

Mirjam Karber ◽

Sebastian Maasberg ◽

...

Keyword(s):

Liver Disease ◽

Liver Function ◽

Parenteral Nutrition ◽

Laboratory Tests ◽

Intestinal Failure ◽

Liver Function Tests ◽

Standard Laboratory ◽

Non Invasive ◽

Function Tests ◽

Over Time

Liver abnormalities in intestinal failure (IF) patients receiving parenteral nutrition (PN) can progress undetected by standard laboratory tests to intestinal failure associated liver disease (IFALD). The aim of this longitudinal study is to evaluate the ability of non-invasive liver function tests to assess liver function following the initiation of PN. Twenty adult patients with IF were prospectively included at PN initiation and received scheduled follow-up assessments after 6, 12, and 24 months between 2014 and 2019. Each visit included liver assessment (LiMAx [Liver Maximum Capacity] test, ICG [indocyanine green] test, FibroScan), laboratory tests (standard laboratory test, NAFLD [non-alcoholic fatty liver disease] score, FIB–4 [fibrosis-4] score), nutritional status (bioelectrical impedance analysis, indirect calorimetry), and quality of life assessment. The patients were categorized post-hoc based on their continuous need for PN into a reduced parenteral nutrition (RPN) group and a stable parenteral nutrition (SPN) group. While the SPN group (n = 9) had significantly shorter small bowel length and poorer nutritional status at baseline compared to the RPN group (n = 11), no difference in liver function was observed between the distinct groups. Over time, liver function determined by LiMAx did continuously decrease from baseline to 24 months in the SPN group but remained stable in the RPN group. This decrease in liver function assessed with LiMAx in the SPN group preceded deterioration of all other investigated liver function tests during the study period. Our results suggest that the liver function over time is primarily determined by the degree of intestinal failure. Furthermore, the LiMAx test appeared more sensitive in detecting early changes in liver function in comparison to other liver function tests.

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