From the Guidelines
FibroScan should not be used to monitor response to treatment in patients with acute alcoholic hepatitis due to the potential for false elevation in liver stiffness readings caused by inflammation. This is based on the evidence from the American Gastroenterological Association institute technical review on the role of elastography in chronic liver diseases 1. The review highlights that noninvasive assessment of cirrhosis, including FibroScan, would be helpful in counseling patients and facilitating appropriate cirrhosis supportive care only after a sustained period of sobriety with resulting reduction in inflammation. Key points to consider include:
- The timing of assessment of liver stiffness is crucial, and inflammation in acute alcoholic hepatitis can increase liver stiffness, leading to false elevation in VCTE readings 1.
- The use of FibroScan in patients with chronic alcoholic liver disease is recommended with a cutoff of 12.5 kPa to detect cirrhosis, but this should not be applied to patients with acute alcoholic hepatitis 1.
- The detection of cirrhosis would not necessarily impact treatment decisions in the absence of effective directed therapy against alcoholic liver disease 1.
- Current monitoring relies heavily on blood tests and clinical assessment, and while FibroScan offers non-invasive, quantitative measurement of liver stiffness, its use in acute alcoholic hepatitis is limited by the potential for false readings. In real-life clinical practice, it is essential to prioritize the accuracy of liver stiffness measurements and avoid potential misclassification of patients, which could lead to unnecessary tests, anxiety, and excessive burden on resource utilization 1.
From the Research
Monitoring Response to Treatment in Acute Alcoholic Hepatitis
- FibroScan, a non-invasive method to evaluate liver stiffness (LS), can be used to monitor response to treatment in patients with acute alcoholic hepatitis, as it has been shown to dramatically reduce LS after abstinence in patients with alcohol-related liver disease 2.
- The study found that LS significantly declined in abstinent patients from 9.2 ± 10.1 kPa at baseline to 6.9 ± 6.1 kPa at 4 weeks, indicating a reduction in liver fibrosis 2.
- However, the accuracy of FibroScan in monitoring response to treatment in acute alcoholic hepatitis is not directly addressed in the provided studies, and its use in this context may be inferred from its application in other liver diseases, such as chronic viral hepatitis 3 and autoimmune hepatitis 4.
- In the context of chronic hepatitis B infection, FibroScan has been used to categorize patients into different fibrosis groups and to monitor the progression of fibrosis during treatment 5.
- The use of FibroScan in acute alcoholic hepatitis may be limited by its failure rate, mainly in obese patients, and its potential overestimation of LS during active drinking 2.
- Further studies are needed to establish the efficacy of FibroScan in monitoring response to treatment in acute alcoholic hepatitis, as the current evidence is based on its use in other liver diseases and its application in alcohol-related liver disease is limited to the context of abstinence 2, 6.