title: Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution.
abstract: Transient elastography (TE) is increasingly employed in clinical practice for the noninvasive detection of tissue fibrosis in patients with chronic liver disease (CLD), and particularly chronic hepatitis C virus (HCV)-related hepatitis. The present study was designed to provide a definitive characterization of the "confounding" increase in liver stiffness (LS) following a standardized meal in a consecutive population of 125 patients with chronic HCV infection at different stages of fibrotic evolution. LS values were obtained after overnight fasting and 15, 30, 45, 60, and 120 minutes following the onset of a standardized liquid meal (400 mL, 600 Kcal, 16.7% protein, 53.8% carbohydrates, 29.5% fat). An evident increase in LS values was observed 15 to 45 minutes after the onset of the meal with return to baseline premeal levels within 120 minutes in all patients. The peak postmeal delta increase in LS was progressively more marked with increasing stages of fibrosis (P < 0.001), becoming maximal in patients with cirrhosis. However, the probability of identifying the Metavir stage of fibrosis, the Child-Pugh class, or the presence/absence of esophageal varices with the postmeal delta increase in LS was inferior to that obtained with baseline LS values.
  
  
  CONCLUSIONS
  The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of LS measurements for the prediction of fibrosis stage in patients with chronic HCV hepatitis and suggest that a fasting period of 120 minutes should be observed before the performance of TE.
authors: Dipartimento di Medicina Interna; Università degli Studi di Firenze/Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy.
authors: Umberto
authors: U
authors: Arena
authors: Monica
authors: M
authors: Lupsor Platon
authors: Cristina
authors: C
authors: Stasi
authors: Stefania
authors: S
authors: Moscarella
authors: Alì
authors: A
authors: Assarat
authors: Giorgio
authors: G
authors: Bedogni
authors: Valeria
authors: V
authors: Piazzolla
authors: Radu
authors: R
authors: Badea
authors: Giacomo
authors: G
authors: Laffi
authors: Fabio
authors: F
authors: Marra
authors: Alessandra
authors: A
authors: Mangia
authors: Massimo
authors: M
authors: Pinzani
mesh_terms: D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D054459:Elasticity Imaging Techniques / Q000379:methods; D005215:Fasting; D005260:Female; D005355:Fibrosis; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D062407:Meals; D008875:Middle Aged