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Guidance for managing complications of liver disease improves

I frequently talk about how to test for or stop liver fibrosis but it is also important to understand how to manage it.  An important consideration is that the disease is usually symptom free until it is severe and there are a lot of medical tests that are needed to manage secondary problems.  It is valuable to know when a particular test would be useful in order to avoid the cost, discomfort, and risk associated with many of them.


The American Gastroenterolgy Association recently released guidelines for how to use Fibroscan to decide whether the liver disease is advanced enough to consider testing for complications of portal hypertension or esophageal varices.

So a little background.  Fibroscan measures liver stiffness which is caused by fibrosis or scarring in the liver which can be the result of a number of causes.  Regardless of why the liver is damaged some secondary problems are typical and are the result of the fibrosis.  Doctors are faced with an array of unknowns because the problems can arise without prior symptoms and can be life threatening.  An important one is varices or ballooning veins in the throat which can burst and lead to sudden death by excessive bleeding.  These are true medical emergencies which can quickly lead to death without warning.

A question then is when should a doctor start watching for these varices so that they can be treated before they become life threatening.  The procedure is to run a tube down your throat and take a look.  It would be useful to have an easy way to know whether it was time to consider that test.

We advocate the use of Fibroscan for earlier screening of people likely to be at risk for liver disease because of the epidemic of fatty liver that is working its way through our generations, but as a treatment tool the work of the AGA is very helpful.  Once a patient becomes involved in a formal medical process it is important to be able to predict what testing is useful and warranted with as little cost and risk as possible.

Clinically, depending on the specific cause of your liver disease a Fibroscan reading of 11 to 12.5 is considered the indication of cirrhosis.  Many people will arrive at a diagnosis of cirrhosis without ever having had a symptom of any kind.  But what then? They will get counseling on weight loss and lifestyle, some diet counseling and be told that sadly there is no treatment.  Whether a person makes the lifestyle choices recommended is another subject, but assuming the disease progresses when should more testing be done?

The AGA has determined that Fibroscan is a useful too to help schedule followup for varices.  Their recommended cutoff is a Fibroscan reading of 17 indicates the development of portal hypertension which are big words for higher pressures because the liver is getting plugged up with scar tissue.  That is an important aspect of the development of the liver disease.  They also say that at 19.5 you should start testing for varices.  This is useful as you deal with the consequences of the disease.

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