Non-invasive diagnosis of cirrhosis and the natural history of its complications.
Several methods have been studied in the attempt to reach a diagnosis of cirrhosis by non-invasive means. Although abdominal ultrasound can detect the hepatic and extra-hepatic changes consistent with cirrhosis, its ability to distinguish chronic hepatitis from compensated cirrhosis is limited. Serum markers can rule in or rule out fibrosis in up to 35% of patients but, in individual patients, cannot differentiate the stages of fibrosis reliably. Transient elastography (Fibroscan) might be of value for the non-invasive diagnosis of cirrhosis; however, its reproducibility needs to be further validated. Cirrhosis can be divided into 4 stages: stage 1, no varices, no ascites; stage 2, varices without ascites and without bleeding; stage 3, ascites+/-varices; stage 4, bleeding+/-ascites. Yearly mortality ranges from 1% in stage 1 to 57% in stage 4. The yearly incidence of oesophageal varices is 5-7%; their rate of enlargement is 10-12% per year. The incidence of variceal bleeding is about 25% at 2 years. Bleeding stops spontaneously in about 50% of cases but early rebleeding occurs in 30-40% of patients. Bleeding-related mortality has declined over time and is now around 20% at 6 weeks.
de Franchis
Roberto
R
IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Department of Medical Sciences, University of Milan, Via Pace 9, 20122 Milan, Italy. roberto.defranchis@unimi.it
Dell'Era
Alessandra
A
D001201:Ascites / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D004548:Elasticity; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography / Q000379:methods
D015415:Biomarkers