Non-invasive Portal Hypertension Diagnosis in HBV- and HCV-related Cirrhosis: A Review

Sipunika Bertici^*
*Correspondence: Sipunika Bertici, Department of Hepatology, West University of Timisoara, 300115 Timisoara, Romania, Email:

Keywords

Portal hypertension • Hepatitis B virus • Hepatitis C virus • Cirrhosis

Introduction

Portal hypertension is a major complication of cirrhosis, arising from increased resistance to portal blood flow and elevated portal venous pressure. It is a hallmark feature of advanced liver disease and is associated with the development of varices, ascites, hepatic encephalopathy and hepatorenal syndrome. Chronic infection with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) is a leading cause of cirrhosis worldwide, making portal hypertension a significant clinical concern in patients with viral hepatitis-related liver disease. The gold standard for diagnosing portal hypertension is Hepatic Venous Pressure Gradient (HVPG) measurement, obtained via invasive transjugular liver catheterization. However, HVPG measurement is not routinely performed due to its invasive nature, cost and risk of complications. Non-invasive methods for portal hypertension diagnosis have therefore garnered increasing attention as alternative tools for risk stratification and prognostication in patients with HBV- and HCV-related cirrhosis. Imaging techniques such as ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play a pivotal role in the non-invasive assessment of portal hypertension-related complications, including splenomegaly, portosystemic collaterals and varices. Ultrasonographic parameters such as spleen size, portal vein diameter and hepatic vein waveform analysis can provide valuable information about the severity of portal hypertension and the risk of variceal bleeding in cirrhotic patients [1].

Transient Elastography (TE), also known as Liver Stiffness Measurement (LSM), is a non-invasive method for assessing liver fibrosis and portal hypertension. TE measures the speed of shear wave propagation through liver tissue, with higher liver stiffness values indicating increased fibrosis and portal pressure. TE has been validated as a reliable tool for predicting the presence of esophageal varices and assessing the risk of variceal bleeding in patients with HBV- and HCV-related cirrhosis. Serum biomarkers such as platelet count, serum albumin and the Platelet-to-Spleen Ratio (PSR) have also been investigated as non-invasive predictors of portal hypertension and cirrhosis-related complications. These biomarkers reflect the degree of hepatic synthetic function, portal hypertension-related thrombocytopenia and splenic sequestration of platelets, providing valuable insights into the hemodynamic status and prognosis of patients with viral hepatitis-related liver disease [2].

Literature Review

Portal hypertension is a significant complication of chronic liver disease, particularly in patients with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)-related cirrhosis. The accurate diagnosis of portal hypertension is crucial for risk stratification, treatment planning and prognostication in this population. Over the years, several non-invasive methods have emerged as valuable tools for assessing portal hypertension in patients with HBV and HCV-related cirrhosis. Imaging techniques such as ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play a pivotal role in the non-invasive assessment of portal hypertension-related complications. Studies have demonstrated the utility of ultrasonographic parameters, including spleen size, portal vein diameter and hepatic vein waveform analysis, in predicting the presence and severity of portal hypertension and the risk of variceal bleeding in cirrhotic patients. Transient Elastography (TE), also known as Liver Stiffness Measurement (LSM), has gained widespread acceptance as a non-invasive method for assessing liver fibrosis and portal hypertension. Numerous studies have validated the accuracy of TE in predicting the presence of esophageal varices and assessing the risk of variceal bleeding in patients with HBV and HCV-related cirrhosis. TE offers several advantages, including its simplicity, reproducibility and ability to provide real-time measurements at the point of care. Serum biomarkers such as platelet count, serum albumin and the Platelet-to-Spleen Ratio (PSR) have also shown promise as non-invasive predictors of portal hypertension and cirrhosis-related complications [3,4].

Discussion

The non-invasive diagnosis of portal hypertension in patients with HBV and HCV-related cirrhosis represents a significant advancement in the management of chronic liver disease. Imaging techniques, transient elastography and serum biomarkers offer valuable alternatives to invasive procedures such as Hepatic Venous Pressure Gradient (HVPG) measurement, facilitating the timely identification of patients at risk of portal hypertension-related complications [5]. While non-invasive methods have demonstrated promising results in the assessment of portal hypertension, several challenges and limitations remain. Variability in imaging interpretation, operator-dependent variability in transient elastography measurements and the influence of confounding factors on serum biomarkers can affect the accuracy and reliability of non-invasive tests. Additionally, the cost and availability of these modalities may limit their widespread adoption, particularly in resource-limited settings. Future research efforts should focus on addressing these limitations and refining non-invasive methods for portal hypertension diagnosis in patients with HBV and HCV-related cirrhosis. Collaborative multicenter studies, prospective validation cohorts and longitudinal follow-up studies are needed to further evaluate the accuracy, reproducibility and clinical utility of non-invasive tests in this population. Moreover, the development of novel biomarkers, imaging techniques and artificial intelligence algorithms holds promise for enhancing the accuracy and efficiency of portal hypertension diagnosis in the future [6].

Conclusion

In conclusion, non-invasive methods for portal hypertension diagnosis have emerged as valuable tools for risk stratification, treatment monitoring and prognostication in patients with HBV and HCV-related cirrhosis. Imaging techniques, transient elastography and serum biomarkers offer non-invasive alternatives to invasive procedures and provide valuable insights into the hemodynamic status and prognosis of patients with viral hepatitis-related liver disease. While non-invasive methods have shown promise in the assessment of portal hypertension, further research is needed to address their limitations and refine their clinical utility. Collaborative efforts between researchers, clinicians and industry partners are essential for advancing the field of non-invasive portal hypertension diagnosis and improving the care and outcomes of patients with HBV and HCV-related cirrhosis.

Acknowledgment

None.

Conflict of Interest

No conflict of interest.

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