Abstract :
Background: Transient elastography (TE) is a non-invasive test for evaluation of fibrosis and cirrhosis
in many chronic liver conditions including chronic viral hepatitis B (CHB) and C (CHC). Studies have shown that
many factors other than fibrosis and cirrhosis influence the liver stiffness measurement (LSM) including high liver
enzymes, cholestasis and conditions that increase liver blood flow such as congestive heart failure and possibly
food intake. Aim of this study is to evaluate the influence of food intake on LSM by TE in patients with CHB and
CHC
Methods: Forty-five patients with CHB and 37 patients with CHC, all without cirrhosis and flare hepati-
tis, underwent LSM after a 4-hour fast. Each patient then ate a standard Thai meal (500 kcal CHO: protein:fat
55:15:30) and the 2 nd and 3 rd LSM measurement were performed immediately and at 1-hr after finishing the meal.
Changes in median values of LSM were compared across times and individual measurements fitted to a random-
intercept, mixed-effects linear regression model to identify differences between CHB and CHC.
Results: LSM increased significantly at both postprandial times, by 0.33 kPa (95% CI 0.20-0.46) and
0.38 kPa (95% CI 0.25-0.51), respectively, in CHB and 0.81 (95% CI 0.63-0.99) and 0.56 (95% CI 0.38-0.75) in
CHC. The immediate increase in LSM after meal was 0.5 kPa (95% CI 0.26-0.71) greater in CHC than in CHB.
There were 73/82 patients (89%) and 74/82 (90.2%) who showed an increase in LSM immediately and at 1 hour
after meal. The 31.7% and 32.9% of these patients had an increase in LSM ≥ 1 kPa.
Conclusions: Postpandrial LSM is significantly elevated compared with fasting LSM. The elevation
remains up to at least 60 minutes. To standardize liver stiffness evaluation, we recommend that the measurement
should be performed after at least 4 hour fasting. |
file/Thai-Journal-of-gastroenterology-vol-14-no-1-4557350.pdf