title: Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension.
abstract: OBJECTIVE
  Liver stiffness is increasingly used in the non-invasive evaluation of chronic liver diseases. Liver stiffness correlates with hepatic venous pressure gradient (HVPG) in patients with cirrhosis and holds prognostic value in this population. Hence, accuracy in its measurement is needed. Several factors independent of fibrosis influence liver stiffness, but there is insufficient information on whether meal ingestion modifies liver stiffness in cirrhosis. We investigated the changes in liver stiffness occurring after the ingestion of a liquid standard test meal in this population.
  
  
  METHODS
  In 19 patients with cirrhosis and esophageal varices (9 alcoholic, 9 HCV-related, 1 NASH; Child score 6.9±1.8), liver stiffness (transient elastography), portal blood flow (PBF) and hepatic artery blood flow (HABF) (Doppler-Ultrasound) were measured before and 30 minutes after receiving a standard mixed liquid meal. In 10 the HVPG changes were also measured.
  
  
  RESULTS
  Post-prandial hyperemia was accompanied by a marked increase in liver stiffness (+27±33%; p<0.0001). Changes in liver stiffness did not correlate with PBF changes, but directly correlated with HABF changes (r = 0.658; p = 0.002). After the meal, those patients showing a decrease in HABF (n = 13) had a less marked increase of liver stiffness as compared to patients in whom HABF increased (n = 6; +12±21% vs. +62±29%,p<0.0001). As expected, post-prandial hyperemia was associated with an increase in HVPG (n = 10; +26±13%, p = 0.003), but changes in liver stiffness did not correlate with HVPG changes.
  
  
  CONCLUSIONS
  Liver stiffness increases markedly after a liquid test meal in patients with cirrhosis, suggesting that its measurement should be performed in standardized fasting conditions. The hepatic artery buffer response appears an important factor modulating postprandial changes of liver stiffness. The post-prandial increase in HVPG cannot be predicted by changes in liver stiffness.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gottardi
authors.forename: Ranka
authors.initials: R
authors.lastname: Vukotic
authors.forename: Sith
authors.initials: S
authors.lastname: Siramolpiwat
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagan
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000368:Aged; D004435:Eating; D004548:Elasticity; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology / Q000503:physiopathology; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D013997:Time Factors