Chronic viral hepatitis: liver biopsy, yes or no?
LB increases costs and has--although minimal--potential risks; however, LB is: a) the gold standard to get to know lesion severity (grade and stage); b) the only method for the diagnosis of an F3 stage, which progresses to liver cirrhosis in approximately 10 years; c) the only method for the certain diagnosis of compensated liver cirrhosis, which requires early diagnosis programs for oesophageal varices and hepatocarcinoma; and d) the only method for the certain diagnosis of lesions predicting a good therapeutic response. On all these grounds--save for exceptions (contraindications, clinical and/or ultrasonographic cirrhosis)--liver biopsy should be carried out in the initial study of all patients. In non-responders to anti-viral therapy liver biopsy should be repeated once or twice with 5-10-year intervals to ascertain fibrosis growth rate and, according to this, plan a most appropriate follow-up. Assuming hepatitis progresses rapidly in all HIV co-infected patients, anti-viral therapy could be administered with no previous LB; such biopsy would be performed in non-responders to decide their course of therapy.
Castellano Tortajada
G
G
Digestive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain. gcastellano@hodc.insalud.es
D001706:Biopsy / Q000191:economics; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000150:complications; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology*; D011379:Prognosis