Assessment of noninvasive liver stiffness in inactive HBsAg carriers by transient elastography: Fibroscan in inactive HBsAg carriers.

BACKGROUND: Chronic viral hepatitis can be evaluated using invasive or noninvasive methods. OBJECTIVES: The aim of this study was to evaluate liver stiffness in inactive HBsAg carriers compared with normal subjects and determine if it is influenced by viral load in these patients. PATIENTS AND METHODS: We prospectively evaluated 140 inactive HBsAg carriers and 152 normal subjects (without any signs or history of liver disease). In all subjects, liver stiffness was measured by 3 experienced physicians using a FibroScan® device (EchoSens, France) per standard procedures. We excluded patients for whom the SR of liver stiffness measurements was < 60% and those who had measurements with an IQR >30%. RESULTS: The mean liver stiffness in inactive HBsAg carriers was 5.6±2.1kPa, significantly higher than in normal subjects (4.8 ± 1.2 kPa, p = 0.0002). In 16.4% (23) of inactive carriers, liver stiffness exceeded 7 kPa (the cutoff for significant fibrosis F ≥ 2). In patients with undetectable viral loads, the mean liver stiffness was 4.9 ± 1.2 kPa, significantly lower than in those with detectable DNA (< 2000 IU/ml) (6.7 ± 2.7 kPa, p < 0.001). CONCLUSIONS: Inactive HBsAg carriers have higher liver stiffness values compared with healthy individuals. Liver stiffness in inactive HBsAg carriers with detectable viral loads is higher than in those who are aviremic, suggesting that low viral loads promote fibrosis.

Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study.

AIM: To assess the values of liver stiffness (LS) in patients with hepatitis B virus (HBV) chronic hepatitis and to compare them with those in patients with hepatitis C virus (HCV) chronic hepatitis. METHODS: The study included 140 patients with HBV chronic hepatitis, and 317 patients with HCV chronic hepatitis, in which LS was measured (FibroScan®-Echosens®) and liver biopsy was performed in the same session (assessed according to the Metavir score). RESULTS: According to the Metavir score of the 140 HBV patients: one had F0, 32 had F1, 67 had F2, 33 had F3 and 7 had F4. Of the 317 HCV patients: 5 had F0, 34 had F1, 146 had F2, 93 had F3 and 39 had F4. For the same severity of fibrosis, the mean values of LS in HBV patients were similar to those in HCV patients: F1, 6.5 ± 1.9 kPa vs 5.8 ± 2.1 kPa (P = 0.0889); F2, 7.1 ± 2 kPa vs 6.9 ± 2.5 kPa (P = 0.3369); F3, 9.1 ± 3.6 kPa vs 9.9 ± 5 kPa (P = 0.7038); F4, 19.8 ± 8.6 kPa vs 17.3 ± 6.1 kPa (P = 0.6574). A significant direct correlation between LS measurements and fibrosis was found in HCV patients (Spearman's r = 0.578, P < 0.0001), as well as in HBV patients (r = 0.408, P < 0.0001). The correlation was more significant in HCV than in HBV patients (Fisher's Z-test, Z = 2.210, P = 0.0271). CONCLUSION: In our group, the mean values of LS in patients with chronic B hepatitis were similar to those in patients with chronic HCV hepatitis, for the same stage of fibrosis. Also, LS was correlated with the severity of fibrosis both in HBV and HCV chronic hepatitis patients.

Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness?

BACKGROUND AND AIM: Chronic liver diseases are investigated through invasive (liver biopsy) or non-invasive (FibroScan or FibroTest) methods. Recently the non-invasive methods have become more and more popular. The aim of this paper is to evaluate the liver stiffness (LS) measured by transient elastography in individuals without known hepatic pathology ("normal" subjects) and to see if it is influenced by age. MATERIAL AND METHOD: We examined a group of "normal" subjects by means of a FibroScan device (EchoSens, France). In each patient we performed 10 valid measurements and a median value was calculated by the device. The subjects were individuals without known hepatic pathology: healthy volunteers or patients from departments other than Gastroenterology in our hospital. RESULTS: We evaluated 152 "normal" subjects (87 women and 65 men, mean age 45.3 + or - 17.6 years). The mean value of LS in "normal" subjects was 4.8 + or - 1.3 kPa, ranging from 2.3 to 8.8 kPa. The mean values of LS in age subgroups were: 18-29 years - 5 + or - 1.3 kPa; 30-39 years - 4.5 + or - 1.2kPa; 40-49 years - 5 = or - 1.1kPa; 50-59 years - 4.7 + or - 1.2kPa; 60-69 years - 5 + or - 1.3kPa; >70 years - 4.7 + or - 1.4kPa. There were no statistically significant differences between the mean values of LS in various age subgroups (p=0.5263). CONCLUSIONS: The mean value of LS measured by transient elastography in "normal" subjects was lower than 5 kPa. Age does not modify the LS.

Peptic upper gastrointestinal bleeding: diagnosis and treatment. A monocentric experience on a 5 years period.

AIM: We evaluated all the cases of upper gastrointestinal hemorrhages admitted in the Department of Endoscopy of our Clinic during a 5 years period. MATERIAL AND METHOD: 810 patients were included in our study, 64.3% males and 36.7% females, mean age 58.7 +/- 15.2 years (17-96 years). The main cause of the upper digestive hemorrhage was peptic ulcer (82.6%), equally divided in gastric and duodenal. All the ulcers were assessed according to the Forrest classification. RESULTS: Endoscopic haemostasis was performed in 40% of all cases, only epinephrine injection (1/10,000) in 44.4% of cases; combined therapy (injection + clip or thermocoagulation) in 40.3% of the cases and clip or thermocoagulation alone in 15.3% of the cases. A marked reduction of haemostasis using epinephrine injection alone (as monotherapy) was observed during the period of study. Postendoscopic treatment rebleeding occurred in 19.8% of cases; 3.6% of the patients have had a fatal outcome and surgical treatment was needed in 2.7% of cases. CONCLUSION: In an experienced Department of Endoscopy, the majority of upper gastrointestinal hemorrhages can be endoscopically treated with good results. In the last years, endoscopical haemostatic bitherapy (adrenaline injection+clipping or bipolar coagulation) replaced injection of adrenaline like monotherapy for ulcer hemostasis.

Comparison of the liver stiffness measurement by transient elastography with the liver biopsy.

AIM: To compare the liver stiffness (LS) measurement by transient elastography (TE) to the liver biopsy (LB)-considered the "gold standard" in the evaluation of patients with chronic hepatitis C. METHODS: During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus (HCV), in which LB and LS assessments (by means of TE) were performed during the same session. RESULTS: Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 +/- 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with significant fibrosis at biopsy (161 patients with F >= 2 according to Metavir) was 9.02 +/- 5.15 kPa, significantly higher than in patients with no or mild fibrosis (30 patients with F < 2 Metavir): 5.39 +/- 1.81 kPa (P < 0.0001). For a cut-off value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis (at least F2 Metavir), with a diagnostic performance of 77.3% (AUROC 0.773). Using this cut-off value, we reached the best discrimination between absence of fibrosis/mild fibrosis (F < 2 Metavir) and the presence of moderate to severe fibrosis (F >= 2 Metavir). CONCLUSION: In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.