title: Liver and spleen stiffness and other noninvasive methods to assess portal hypertension in cirrhotic patients: a review of the literature.
abstract: Portal hypertension (PH) is one of the most important causes of morbidity and mortality in patients with chronic liver disease. PH measurement is crucial to stage and predict the clinical outcome of liver cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for assessment of the degree of PH; however, it is an invasive method and has not been used widely. Thus, noninvasive methods have been proposed recently. We critically evaluated serum markers, abdominal ultrasonography, and particularly liver and spleen stiffness measurement, which represent the more promising methods to stage PH degree and to assess the presence/absence of esophageal varices (EV). A literature search was carried out on MEDLINE, EMBASE, Web of Science, and Scopus for articles and abstracts. The search terms used included 'liver cirrhosis', 'portal hypertension', 'liver stiffness', 'spleen stiffness', 'ultrasonography', and 'portal hypertension serum biomarker'. The articles cited were selected on the basis of their relevance to the objective of the review. The results of available studies indicate that individually, these methods have a mild accuracy in predicting the presence of EV, and thus they cannot substitute endoscopy to predict EV. When these tests were used in combination, their accuracy increased. In addition to the PH staging, several serum markers and spleen stiffness measurement can predict the clinical outcome of liver cirrhosis with a good accuracy, comparable to that of hepatic vein pressure gradient. In the future, noninvasive methods could be used to select patients requiring further investigations to identify the best tailored clinical management.
authors.affiliation: aDepartment of Gastrointestinal Diseases and Internal Medicine, University of Bologna, Bologna bDepartment of Pediatrics, University of Modena, Modena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marasco
authors.forename: Martina
authors.initials: M
authors.lastname: Taddia
authors.forename: Lucia
authors.initials: L
authors.lastname: Montrone
authors.forename: Leonardo H
authors.initials: LH
authors.lastname: Eusebi
authors.forename: Daniele
authors.initials: D
authors.lastname: Mandolesi
authors.forename: Ramona
authors.initials: R
authors.lastname: Schiumerini
authors.forename: Anna R
authors.initials: AR
authors.lastname: Di Biase
authors.forename: Davide
authors.initials: D
authors.lastname: Festi
mesh_terms: D015415:Biomarkers / Q000097:blood; D054459:Elasticity Imaging Techniques; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013154:Spleen / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D018608:Ultrasonography, Doppler
chemical_list: D015415:Biomarkers