Abstract
Background and AimsLiver stiffness is increasingly used in the non-invasive evaluation of chronic liver diseases. Liver stiffness correlates with hepatic venous pressure gradient (HVPG) in patients with cirrhosis and holds prognostic value in this population. Hence, accuracy in its measurement is needed. Several factors independent of fibrosis influence liver stiffness, but there is insufficient information on whether meal ingestion modifies liver stiffness in cirrhosis. We investigated the changes in liver stiffness occurring after the ingestion of a liquid standard test meal in this population.MethodsIn 19 patients with cirrhosis and esophageal varices (9 alcoholic, 9 HCV-related, 1 NASH; Child score 6.9±1.8), liver stiffness (transient elastography), portal blood flow (PBF) and hepatic artery blood flow (HABF) (Doppler-Ultrasound) were measured before and 30 minutes after receiving a standard mixed liquid meal. In 10 the HVPG changes were also measured.ResultsPost-prandial hyperemia was accompanied by a marked increase in liver stiffness (+27±33%; p<0.0001). Changes in liver stiffness did not correlate with PBF changes, but directly correlated with HABF changes (r = 0.658; p = 0.002). After the meal, those patients showing a decrease in HABF (n = 13) had a less marked increase of liver stiffness as compared to patients in whom HABF increased (n = 6; +12±21% vs. +62±29%,p<0.0001). As expected, post-prandial hyperemia was associated with an increase in HVPG (n = 10; +26±13%, p = 0.003), but changes in liver stiffness did not correlate with HVPG changes.ConclusionsLiver stiffness increases markedly after a liquid test meal in patients with cirrhosis, suggesting that its measurement should be performed in standardized fasting conditions. The hepatic artery buffer response appears an important factor modulating postprandial changes of liver stiffness. The post-prandial increase in HVPG cannot be predicted by changes in liver stiffness.
Highlights
Liver stiffness (LS) measurement by transient elastography is a non-invasive ultrasound-based technique increasingly used to estimate the degree of fibrosis in patients with chronic liver diseases [1]
Changes in liver stiffness did not correlate with portal blood flow (PBF) changes, but directly correlated with hepatic artery blood flow (HABF) changes (r = 0.658; p = 0.002)
Post-prandial hyperemia was associated with an increase in hepatic venous pressure gradient (HVPG) (n = 10; +26613%, p = 0.003), but changes in liver stiffness did not correlate with HVPG changes
Summary
Liver stiffness (LS) measurement by transient elastography is a non-invasive ultrasound-based technique increasingly used to estimate the degree of fibrosis in patients with chronic liver diseases [1]. Since liver fibrosis is the major factor contributing to portal hypertension [2], LS is able to predict the presence of portal hypertension in patients with cirrhosis [2] In this population increasing values of LS are associated [3] and predict [4] clinical end-points such as portal hypertension-related complications and hepatocellular carcinoma [5]. It has been proposed that meals may influence LS in patients with mild chronic hepatitis [14], but there is no information on the post-prandial variation of LS in patients with cirrhosis, who represent the population at risk of clinical events. We investigated the changes in liver stiffness occurring after the ingestion of a liquid standard test meal in this population
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