Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B

Wong, Grace L.H.; Wong, Vincent Wai‐Sun; Choi, Pui–Wah; Chan, Anthony W.H.; Chim, Angel Mei‐Ling; Yiu, Karen; Chan, Francis K.L.; Sung, Joseph J.Y.; Chan, H.L.Y.

doi:10.1111/j.1440-1746.2009.05779.x

Cited by 107 publications

(92 citation statements)

References 27 publications

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“…LSM should therefore be assessed after normalization of ALT levels in order to accurately diagnose the degree of fibrosis. 86 Liang et al 87 performed dynamic evaluation of LSM in patients with CHB-AE and found that as ALT normalized, LSMs remained over 12.0 kPa in patients with cirrhosis while in patients without cirrhosis the LSMs decreased in parallel with normalization of ALT and bilirubin levels. Hence elevated LSM after the ALT and bilirubin normalization may help diagnosing cirrhosis and confirm underlying chronic liver disease.…”

Section: Transient Elastographymentioning

confidence: 99%

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Puri

2013

Journal of Clinical and Experimental Hepatology

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Exacerbations of chronic hepatitis B are common in endemic countries. Acute exacerbation of chronic hepatitis B virus (CHB-AE) causing derangement of liver functions may be seen in a flare of HBV in immune clearance phase or as a reactivation of HBV in patients with inactive or resolved HBV infection. While reactivation of HBV is usually seen in HBsAg positive patients, it is being increasingly recognized in patients with apparently resolved HBV infection who do not have HBsAg in serum but have IgG antibody to core antigen (anti-HBc) in the serum, especially so in patients on chemotherapy, immunosuppressive therapy or undergoing hematopoietic stem cell transplantation. In an icteric patient who is HBsAg positive, it may be difficult to differentiate CHB-AE from acute viral hepatitis B (AVH-B). Both may have similar clinical presentation and even IgM anti-HBc, the traditional diagnostic marker of AVH-B, may also appear at the time of exacerbation of CHB. The differentiation between CHB-AE and AVH-B is important not only for prognostication but also because management strategies are different. Most cases of AVH-B will resolve on their own, HBsAg clearance is achieved spontaneously in 90-95% of adults and treatment is rarely indicated except in the few with severe/fulminant disease. In contrast, in CHB-AE, the onset of jaundice may lead to decompensation of liver disease and treatment is warranted. The mechanisms of acute exacerbation and the differentiating features between AVH-B and CHB-AE are reviewed. ( J CLIN EXP HEPATOL 2013;3:301-312)

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Section: Transient Elastographymentioning

confidence: 99%

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Puri

2013

Journal of Clinical and Experimental Hepatology

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“…[23,24] It can be less accurate in certain situation, e.g. severe acute exacerbation of hepatitis, [25] post-treatment fibrosis stages in CHB [26] or chronic hepatitis C (CHC) patients.…”

Section: Transient Elastographymentioning

confidence: 99%

Advances in the diagnosis and treatment of liver fibrosis

Cheng¹,

Wong²

2017

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“…Instead, only BMI and steatosis grade correlated positively with CAP. Thus, while a high ALT level independently increases liver stiffness and can contribute toward a false diagnosis of cirrhosis [18], CAP does not suffer from the same confounding issues.…”

mentioning

confidence: 99%

Fat and Fiber: How the Controlled Attenuation Parameter Complements Noninvasive Assessment of Liver Fibrosis

Wong

2014

Dig Dis Sci

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Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B

Abstract: LSM using transient elastography with the current proposed cut-off values might misdiagnose liver cirrhosis in patients suffering from severe acute exacerbation of CHB. LSM should be assessed after normalization of ALT levels in order to accurately assess the degree of fibrosis.

Cited by 107 publications

References 27 publications

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Acute Exacerbation of Chronic Hepatitis B: The Dilemma of Differentiation from Acute Viral Hepatitis B

Advances in the diagnosis and treatment of liver fibrosis

Fat and Fiber: How the Controlled Attenuation Parameter Complements Noninvasive Assessment of Liver Fibrosis

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