Potential conflict of interest: Nothing to report.
Liver stiffness after meal intake at different stages of fibrotic evolution
Article first published online: 18 DEC 2013
© 2013 by the American Association for the Study of Liver Diseases
Volume 59, Issue 2, pages 734–735, February 2014
How to Cite
Mederacke, I. and Bahr, M. J. (2014), Liver stiffness after meal intake at different stages of fibrotic evolution. Hepatology, 59: 734–735. doi: 10.1002/hep.26513
- Issue published online: 29 JAN 2014
- Article first published online: 18 DEC 2013
- Accepted manuscript online: 23 MAY 2013 04:15PM EST
- Manuscript Accepted: 2 MAY 2013
- Manuscript Received: 29 APR 2013
To the Editor:
With great interest, we read the study by Arena et al. showing an increase in liver stiffness 15 to 45 minutes after the intake of a standardized liquid meal lowering the accuracy of fibrosis assessment by transient elastography (TE). These results are in line with another study using liquid meals and our previous findings obtained under “real-life” conditions using standardized solid meals. Similarly, liver stiffness as assessed by acoustic radiation force impulse (ARFI) elastography is influenced by food intake.
In patients with cirrhosis, Berzigotti et al. showed that increased hepatic arterial but not portal blood flow is responsible for the increase of liver stiffness after food intake.
Unfortunately, the initial studies on liver stiffness determination using TE did not explicitly pay regard to currently known confounding factors (Table 1). TE appeared to be reasonably accurate to distinguish cirrhosis from precirrhotic stages, and severe fibrosis from early fibrosis. However, early fibrosis stages exhibited considerable overlap in liver stiffness measurement. Final assessment was hampered by the limitations of liver biopsy as the reference method. Although knowledge of confounding factors of TE might raise speculations that “optimized” TE could even outperform histology, we should not forget that liver stiffness indicates hepatic collagen content rather than a histological picture and that there is significant overlap of hepatic collagen content in the different stages of fibrosis.[7, 8] Thus, taking hepatic collagen content instead of histologically defined stages might improve revelation of the full performance of TE if measurement is performed under standardized conditions with accepted reliability criteria. However, the ultimate test will be the prediction of clinically relevant endpoints.
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Ingmar Mederacke, M.D.1
Matthias J. Bahr, M.D.2
1Hannover Medical School
Gastroenterology, Hepatology and Endocrinology
2Sana Kliniken Luebeck