A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases

2016 ◽  
Vol 50 (8) ◽  
pp. 658-663 ◽  
Author(s):  
Silja Voutilainen ◽  
Reetta Kivisaari ◽  
Jouko Lohi ◽  
Hannu Jalanko ◽  
Mikko P. Pakarinen
Keyword(s):  
Liver Fibrosis ◽  
Esophageal Varices ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Prospective Comparison

scholarly journals Physicians’ Practices for Diagnosing Liver Fibrosis in Chronic Liver Diseases: A Nationwide, Canadian Survey

2014 ◽  
Vol 28 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Giada Sebastiani ◽  
Peter Ghali ◽  
Philip Wong ◽  
Marina B Klein ◽  
Marc Deschenes ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Routine Assessment

OBJECTIVE: To determine practices among physicians in Canada for the assessment of liver fibrosis in patients with chronic liver diseases.METHODS: Hepatologists, gastroenterologists, infectious diseases specialists, members of the Canadian Gastroenterology Association and/or the Canadian HIV Trials Network who manage patients with liver diseases were invited to participate in a web-based, national survey.RESULTS: Of the 237 physicians invited, 104 (43.9%) completed the survey. Routine assessment of liver fibrosis was requested by the surveyed physicians mostly for chronic hepatitis C (76.5%), followed by autoimmune/cholestatic liver disease (59.6%) and chronic hepatitis B (52.9%). Liver biopsy was the main diagnostic tool for 46.2% of the respondents, Fibroscan (Echosens, France) for 39.4% and Fibrotest (LabCorp, USA) for 7.7%. Etiology-specific differences were observed: noninvasive methods were mostly used for hepatitis C (63% versus 37% liver biopsy) and hepatitis B (62.9% versus 37.1% liver biopsy). For 42.7% of respondents, the use of noninvasive methods reduced the need for liver biopsy by >50%. Physicians’ characteristics associated with higher use of noninvasive methods were older age and being based at a university hospital or in private practice versus community hospital. Physicians’ main concerns regarding noninvasive fibrosis assessment methods were access/availability (42.3%), lack of guidelines for clinical use (26.9%) and cost/lack of reimbursement (14.4%).CONCLUSIONS: Physicians who manage patients with chronic liver diseases in Canada require routine assessment of liver fibrosis stage. Although biopsy remains the primary diagnostic tool for almost one-half of respondents, noninvasive methods, particularly Fibroscan, have significantly reduced the need for liver biopsy in Canada. Limitations in access to and availability of the noninvasive methods represent a significant barrier. Finally, there is a need for clinical guidelines and a better reimbursement policy to implement noninvasive tools to assess liver fibrosis.

scholarly journals Factors That Could Impact on Liver Fibrosis Staging by Transient Elastography

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Hugo Perazzo ◽  
Valdilea G. Veloso ◽  
Beatriz Grinsztejn ◽  
Chris Hyde ◽  
Rodolfo Castro
Keyword(s):  
Liver Fibrosis ◽  
Liver Diseases ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Extrahepatic Cholestasis ◽  
The Impact ◽  
Fibrosis Staging

Transient elastography (TE) based on liver stiffness measurement (LSM) is one of the most validated noninvasive methods for liver fibrosis staging in patients with chronic liver diseases. This method is painless, has no potential complications, is rapid (<10 min), and can be performed at the patient’s bedside. However, several points should be considered when interpreting TE results. This review aims to discuss the critical points that might influence liver stiffness and TE results. Spectrum bias and the impact of the prevalence of fibrosis stages should be taken into account when interpreting the studies that validated this method using liver biopsy as a gold-standard. LSM might be influenced by nonfasting status, flare of transaminases, heart failure, extrahepatic cholestasis, presence of steatosis, aetiology of liver disease, type and position of probe, and operator’s experience. In addition, interobserver variability can impact on the management of patients with chronic liver diseases. TE should be performed by an experienced operator (>100 exams), in a 3-hour fasting status, and its results should be handled by specialist clinicians that are aware of the limitations of this method.

scholarly journals The Role of the Gut Microbiome in Liver Cirrhosis Treatment

2020 ◽  
Vol 22 (1) ◽  
pp. 199
Author(s):  
Na Young Lee ◽  
Ki Tae Suk
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Gut Microbiota ◽  
Gut Microbiome ◽  
Liver Diseases ◽  
Sclerosing Cholangitis ◽  
Chronic Liver ◽  
Chronic Liver Diseases

Liver cirrhosis is one of the most prevalent chronic liver diseases worldwide. In addition to viral hepatitis, diseases such as steatohepatitis, autoimmune hepatitis, sclerosing cholangitis and Wilson’s disease can also lead to cirrhosis. Moreover, alcohol can cause cirrhosis on its own and exacerbate chronic liver disease of other causes. The treatment of cirrhosis can be divided into addressing the cause of cirrhosis and reversing liver fibrosis. To this date, there is still no clear consensus on the treatment of cirrhosis. Recently, there has been a lot of interest in potential treatments that modulate the gut microbiota and gut-liver axis for the treatment of cirrhosis. According to recent studies, modulation of the gut microbiome by probiotics ameliorates the progression of liver disease. The precise mechanism for relieving cirrhosis via gut microbial modulation has not been identified. This paper summarizes the role and effects of the gut microbiome in cirrhosis based on experimental and clinical studies on absorbable antibiotics, probiotics, prebiotics, and synbiotics. Moreover, it provides evidence of a relationship between the gut microbiome and liver fibrosis.

scholarly journals Novel Laboratory Tests in Assessment of Liver Function in Acute and Chronic Liver Diseases

2009 ◽  
Vol 63 (4-5) ◽  
pp. 228-233
Author(s):  
Ludmila Vīksna ◽  
Jāzeps Keišs ◽  
Artūrs Sočņevs ◽  
Baiba Rozentāle ◽  
Māra Pilmane ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Biopsy ◽  
Liver Diseases ◽  
Laboratory Tests ◽  
Serum Markers ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Disease Evolution ◽  
Prognostic Accuracy

Novel Laboratory Tests in Assessment of Liver Function in Acute and Chronic Liver Diseases Liver biopsy in clinical practice has been widely used for the diagnosis and management of patients with liver diseases, particularly, with chronic liver diseases. However, liver biopsy is an invasive method with potential complications, sampling and interpretation errors. Therefore, noninvasive tests are being developed and introduced to replace liver biopsy. The aim of the present study was to identify the new noninvasive methods to be used for the assessment of liver structure and function, by use of the appropriate serum surrogate markers and to evaluate the clinical diagnostic and prognostic accuracy of these methods, including immunogenetic methods, in cases of acute and chronic liver diseases. The obtained data showed that serum markers of apoptosis (cytokeratin-18 neoepitope and citochrome c) and fibrosis (hyaluronic acid) should be included in viral and toxic liver damage management algorithms. The punctual identification of immunogenetic factors (HLA class II antigens) may prove to be useful in predicting disease evolution, and in guiding the appropriate therapy for patients with poor prognosis.

scholarly journals Growth differentiation factor 11 attenuates liver fibrosis via expansion of liver progenitor cells

Gut ◽  
2019 ◽  
Vol 69 (6) ◽  
pp. 1104-1115 ◽  
Author(s):  
Zhen Dai ◽  
Guangqi Song ◽  
Asha Balakrishnan ◽  
Taihua Yang ◽  
Qinggong Yuan ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Progenitor Cells ◽  
Liver Diseases ◽  
Transcriptional Control ◽  
Cell Types ◽  
Protective Role ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Differentiation Factor

ObjectiveLiver fibrosis and cirrhosis resulting from chronic liver injury represent a major healthcare burden worldwide. Growth differentiation factor (GDF) 11 has been recently investigated for its role in rejuvenation of ageing organs, but its role in chronic liver diseases has remained unknown. Here, we investigated the expression and function of GDF11 in liver fibrosis, a common feature of most chronic liver diseases.DesignWe analysed the expression of GDF11 in patients with liver fibrosis, in a mouse model of liver fibrosis and in hepatic stellate cells (HSCs) as well as in other liver cell types. The functional relevance of GDF11 in toxin-induced and cholestasis-induced mouse models of liver fibrosis was examined by in vivo modulation of Gdf11 expression using adeno-associated virus (AAV) vectors. The effect of GDF11 on leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5)+ liver progenitor cells was studied in mouse and human liver organoid culture. Furthermore, in vivo depletion of LGR5+ cells was induced by injecting AAV vectors expressing diptheria toxin A under the transcriptional control of Lgr5 promoter.ResultsWe showed that the expression of GDF11 is upregulated in patients with liver fibrosis and in experimentally induced murine liver fibrosis models. Furthermore, we found that therapeutic application of GDF11 mounts a protective response against fibrosis by increasing the number of LGR5+ progenitor cells in the liver.ConclusionCollectively, our findings uncover a protective role of GDF11 during liver fibrosis and suggest a potential application of GDF11 for the treatment of chronic liver disease.

NONINVASIVE ASSESSMENT OF HEPATIC FIBROSIS

2014 ◽  
pp. 5-11
Author(s):  
Thi Khanh Tuong Tran ◽  
Trong Thang Hoang
Keyword(s):  
Clinical Practice ◽  
Liver Fibrosis ◽  
Hepatic Fibrosis ◽  
Liver Stiffness ◽  
Treatment Decision ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Noninvasive Methods ◽  
Non Invasive ◽  
Noninvasive Assessment

Staging of hepatic fibrosis is crucial for prognosis, surveillance and treatment decision in patients with chronic liver diseases in clinical practice. Liver biopsy has still the gold standard for assessment of hepatic fibrosis, but it has some limitations. To overcome this, non-invasive methods were developed. The methods of noninvasive assessment of liver fibrosis were divided into two main groups: serum biomarkers and techniques measuring liver stiffness. Each method has its own advantages and limits. Some studies suggest that the effectiveness of noninvasive methods for assessing liver fibrosis may increase when they are combined. The aim of this article is to review and update the different non invasive methods for assessment of hepatic fibrosis, their advantages, disadvantages, diagnostic accuracy and their applications in clinical practice. Key words: hepatic fibrosis, liver stiffness, chronic liver disease

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