Liver stiffness is influenced by a standardized meal in... : Hepatology (original) (raw)

Viral Hepatitis

Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution

Arena, Umberto1,*; Platon, Monica Lupsor2,*; Stasi, Cristina1; Moscarella, Stefania1; Assarat, Alì1; Bedogni, Giorgio3; Piazzolla, Valeria4; Badea, Radu2; Laffi, Giacomo1; Marra, Fabio1,5; Mangia, Alessandra4; Pinzani, Massimo5,6

1_Dipartimento di Medicina Interna; Università degli Studi di Firenze/Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy_

2_Department of Ultrasonography, Regional Institute of Gastroenterology and Hepatology “Prof Dr Octavian Fodor”, University of Medicine and Pharmacy Iuliu-Hatieganu, Cluj-Napoca, Romania_

3_Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy and Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy_

4_Liver Unit, IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo, Foggia, Italy_

5_Center for Research, Higher Education and Transfer “DENOThe,” Università degli Studi di Firenze/Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy_

6_UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom_

Received November 17, 2012; accepted February 14, 2013.

*Theses authors contributed equally to this study.

Address reprint requests to: Prof. Massimo Pinzani, M.D., Ph.D., F.R.C.P., Sheila Sherlock Chair of Hepatology, Director, UCL Institute for Liver and Digestive Health, University College London, Royal Free Hospital Campus U3, Rowland Hill Street, London, NW3 2PF, UK. Email:[email protected]

Potential conflict of interest: Dr. Mangia consults for Janssen and is on the speakers' bureau for Roche.

Abstract

Transient elastography (TE) is increasingly employed in clinical practice for the noninvasive detection of tissue fibrosis in patients with chronic liver disease (CLD), and particularly chronic hepatitis C virus (HCV)-related hepatitis. The present study was designed to provide a definitive characterization of the “confounding” increase in liver stiffness (LS) following a standardized meal in a consecutive population of 125 patients with chronic HCV infection at different stages of fibrotic evolution. LS values were obtained after overnight fasting and 15, 30, 45, 60, and 120 minutes following the onset of a standardized liquid meal (400 mL, 600 Kcal, 16.7% protein, 53.8% carbohydrates, 29.5% fat). An evident increase in LS values was observed 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 LS was progressively more marked with increasing stages of fibrosis (P < 0.001), 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 LS was inferior to that obtained with baseline LS values. Conclusion: The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of LS measurements for the prediction of fibrosis stage in patients with chronic HCV hepatitis and suggest that a fasting period of 120 minutes should be observed before the performance of TE. (HEPATOLOGY 2013;)