Non-Invasive Methods of Diagnosing Complications of Liver Cirrhosis
Secondary to NAFLD (Portal Hypertension and Variceal Bleeding)
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a significant
global health concern, affecting around 25% of adults worldwide. From
simple steatosis to non-alcoholic steatohepatitis (NASH), the
progression can lead to severe complications like fibrosis, cirrhosis,
and liver cancer. Current diagnostic methods such as hepatic venous
pressure gradient (HVPG) measurement and endoscopy are expensive,
inaccessible, and risky. Objectives This review evaluates non-invasive
techniques for diagnosing portal hypertension and variceal bleeding in
patients with NAFLD cirrhosis. The goal is to identify reliable
non-invasive diagnostic strategies and compare them with invasive
procedures like HVPG and esophagogastroduodenoscopy (EGD). Methods By
conducting a thorough literature search on PubMed, Cochrane Library,
Google Scholar, and ScienceDirect, relevant studies were selected based
on specific criteria. These studies focused on non-invasive diagnostic
methods for portal hypertension and variceal bleeding in adult
participants with confirmed NAFLD cirrhosis. Results Among the 11
studies involving 2,707 patients, liver stiffness measurement (LSM)
using transient elastography showed significant sensitivity (85%) and
specificity (79%) in diagnosing clinically significant portal
hypertension (CSPH). LSM, when combined with platelet count, exhibited
high sensitivity (97-98%) in detecting esophageal varices (EV) and
high-risk esophageal varices (HREV), albeit with lower specificity
(32-74%). Spleen stiffness measurement (SSM) demonstrated good
diagnostic performance, with a sensitivity of 89% and specificity of
75% for CSPH. Conclusion Non-invasive tests like LSM and SSM exhibit
promising diagnostic accuracy for identifying portal hypertension and
variceal bleeding in NAFLD patients. The high sensitivity of these
tests, especially in combination, supports their role in clinically
ruling out these conditions. LSM, particularly at higher thresholds,
shows specificity in confirming diagnoses of CSPH, severe portal
hypertension (SPH), and high-risk esophageal varices (HREV).