March 04, 2013
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Meal consumption confounds liver stiffness measurements in patients with chronic HCV

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Liver stiffness varied significantly during a 2-hour period after consumption of a meal, and it impaired detection of fibrosis and esophageal varices in patients with chronic hepatitis C in a recent study.

Researchers measured liver stiffness (LS) via transient elastography (TE) in 125 patients aged 20 to 78 years with chronic HCV following an overnight fast and 15, 30, 45, 60 and 120 minutes after consumption of a standardized liquid meal. The cohort included 40 patients with cirrhosis, 50 with mild or no fibrosis and 35 with significant or advanced fibrosis. Among patients with cirrhosis, 27 were classified Child-Turcotte-Pugh class A and 13 Child-Turcotte-Pugh class B, and esophageal varices were observed in 20 cases.

LS increased within 15 to 45 minutes of meal consumption, then returned to baseline values by the 120-minute measurement in all cases. Patients with more advanced fibrosis, especially cirrhosis, had significantly greater LS compared with those with a lower fibrosis stage at all evaluated time points. They also had a greater overall change, although the percentage change was significantly greater among those with less severe fibrosis (P<.001 for all comparisons).

Investigators noted that the use of LS values collected at any time point following consumption of the meal had a lower probability of accurately detecting fibrosis stage, Child-Turcotte-Pugh class or esophageal varices compared with LS values at baseline.

“During the past decade, TE has been shown to represent an important tool for the assessment of the fibrotic evolution of chronic liver disease, particularly chronic HCV,” the researchers wrote. “The identification of factors negatively affecting the diagnostic accuracy of TE is absolutely crucial.

“The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of LS measurements and suggest that a fasting period of 120 minutes should be observed before the performance of TE.”