Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?

Elton Dajti,1,2 Luigina Vanessa Alemanni,1,2 Giovanni Marasco,1,2 Marco Montagnani,1,2 Francesco Azzaroli1,2 1IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyCorrespondence: Francesco Azzar...

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Autores principales:	Dajti E, Alemanni LV, Marasco G, Montagnani M, Azzaroli F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	liver stiffness spleen stiffness portal hypertension hepatic venous pressure gradient liver cirrhosis. Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/2f5454ae176b409f86893bbfb674b540
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spelling	oai:doaj.org-article:2f5454ae176b409f86893bbfb674b5402021-12-02T14:13:58ZApproaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?1179-1535https://doaj.org/article/2f5454ae176b409f86893bbfb674b5402021-03-01T00:00:00Zhttps://www.dovepress.com/approaches-to-the-diagnosis-of-portal-hypertension-non-invasive-or-inv-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Elton Dajti,1,2 Luigina Vanessa Alemanni,1,2 Giovanni Marasco,1,2 Marco Montagnani,1,2 Francesco Azzaroli1,2 1IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyCorrespondence: Francesco AzzaroliIRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyEmail francesco.azzaroli@unibo.itAbstract: Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD) and is defined by values of hepatic venous pressure gradient measurement (HVPG) > 5 mmHg. Values of HVPG ≥ 10 mmHg determine the presence of clinically significant portal hypertension (CSPH), the main predictor of the risk of variceal bleeding, hepatic decompensation, and mortality. However, its measurement is invasive and requires high expertise, so its routine use outside third level centers or clinical trials is limited. In the last decades, several non-invasive tests (NITs) have been developed and validated for the diagnosis of portal hypertension. Among these, liver (LSM) and spleen stiffness measurement (SSM) are the most promising tools available, as they have been proven accurate to predict CSPH, high-risk esophageal varices, decompensation, and mortality in patients with ACLD. In the last Baveno VI Consensus proceedings, LSM evaluation was recommended for the first time for diagnosis of CSPH (LSM > 20-25 kPa) and the screening of patients with a low probability of having high-risk varices (LSM < 20 kPa and platelet count > 150.000/mm3). In this review, we aimed to summarize the growing evidence supporting the use of non-invasive tests for the evaluation of portal hypertension in patients with chronic liver disease.Keywords: liver stiffness, spleen stiffness, portal hypertension, hepatic venous pressure gradient, liver cirrhosisDajti EAlemanni LVMarasco GMontagnani MAzzaroli FDove Medical Pressarticleliver stiffnessspleen stiffnessportal hypertensionhepatic venous pressure gradientliver cirrhosis.Diseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 13, Pp 25-36 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	liver stiffness spleen stiffness portal hypertension hepatic venous pressure gradient liver cirrhosis. Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	liver stiffness spleen stiffness portal hypertension hepatic venous pressure gradient liver cirrhosis. Diseases of the digestive system. Gastroenterology RC799-869 Dajti E Alemanni LV Marasco G Montagnani M Azzaroli F Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
description	Elton Dajti,1,2 Luigina Vanessa Alemanni,1,2 Giovanni Marasco,1,2 Marco Montagnani,1,2 Francesco Azzaroli1,2 1IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyCorrespondence: Francesco AzzaroliIRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyEmail francesco.azzaroli@unibo.itAbstract: Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD) and is defined by values of hepatic venous pressure gradient measurement (HVPG) > 5 mmHg. Values of HVPG ≥ 10 mmHg determine the presence of clinically significant portal hypertension (CSPH), the main predictor of the risk of variceal bleeding, hepatic decompensation, and mortality. However, its measurement is invasive and requires high expertise, so its routine use outside third level centers or clinical trials is limited. In the last decades, several non-invasive tests (NITs) have been developed and validated for the diagnosis of portal hypertension. Among these, liver (LSM) and spleen stiffness measurement (SSM) are the most promising tools available, as they have been proven accurate to predict CSPH, high-risk esophageal varices, decompensation, and mortality in patients with ACLD. In the last Baveno VI Consensus proceedings, LSM evaluation was recommended for the first time for diagnosis of CSPH (LSM > 20-25 kPa) and the screening of patients with a low probability of having high-risk varices (LSM < 20 kPa and platelet count > 150.000/mm3). In this review, we aimed to summarize the growing evidence supporting the use of non-invasive tests for the evaluation of portal hypertension in patients with chronic liver disease.Keywords: liver stiffness, spleen stiffness, portal hypertension, hepatic venous pressure gradient, liver cirrhosis
format	article
author	Dajti E Alemanni LV Marasco G Montagnani M Azzaroli F
author_facet	Dajti E Alemanni LV Marasco G Montagnani M Azzaroli F
author_sort	Dajti E
title	Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
title_short	Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
title_full	Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
title_fullStr	Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
title_full_unstemmed	Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?
title_sort	approaches to the diagnosis of portal hypertension: non-invasive or invasive tests?
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/2f5454ae176b409f86893bbfb674b540
work_keys_str_mv	AT dajtie approachestothediagnosisofportalhypertensionnoninvasiveorinvasivetests AT alemannilv approachestothediagnosisofportalhypertensionnoninvasiveorinvasivetests AT marascog approachestothediagnosisofportalhypertensionnoninvasiveorinvasivetests AT montagnanim approachestothediagnosisofportalhypertensionnoninvasiveorinvasivetests AT azzarolif approachestothediagnosisofportalhypertensionnoninvasiveorinvasivetests
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Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?

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