Skip to main content

SYSTEMATIC REVIEW article

Front. Med.
Sec. Gastroenterology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1459569
This article is part of the Research Topic Treatment and Prognostic Assessment of Liver Cirrhosis and Its Complications, Volume II View all 20 articles

Non-Invasive Methods for Diagnosing Portal Hypertension and Variceal Bleeding due to Liver Cirrhosis Secondary to NAFLD/ MASLD: Systematic Review

Provisionally accepted
Nebyu Yonas Shanka Nebyu Yonas Shanka 1*Leul Mekonnen Nigatu Leul Mekonnen Nigatu 2Chavdar S Pavlov Chavdar S Pavlov 3
  • 1 Department of Postgraduate and Doctoral Studies, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  • 2 Department of Public Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  • 3 Department of therapy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

The final, formatted version of the article will be published soon.

    Background: Non-alcoholic fatty liver disease (NAFLD), recently re-termed as metabolic dysfunction-associated steatotic liver disease (MASLD), is a global health concern affecting approximately 25% of adults. Complications such as portal hypertension and variceal bleeding are critical to diagnose but challenging with traditional invasive methods like hepatic venous pressure gradient (HVPG) measurement and esophagogastroduodenoscopy (EGD), which are not always feasible and carry risks.Objectives: This systematic review aim to evaluate the diagnostic accuracy of non-invasive methods for diagnosing portal hypertension and variceal bleeding in patients with NAFLD/MASLD cirrhosis, comparing these methods to invasive standards.Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Google Scholar, and ScienceDirect from January 2000 to May 2024. Studies included evaluated non-invasive diagnostic techniques for portal hypertension and variceal bleeding, compared with HVPG and EGD, focusing on adult patients with confirmed NAFLD/MASLD cirrhosis. Data extraction covered study characteristics and diagnostic accuracy metrics. The quality of studies was assessed using the QUADAS-2 tool. Meta-analyses were performed using R and Python.Results: 11 studies involving 2,707 patients met the inclusion criteria. Liver stiffness measurement (LSM) via transient elastography demonstrated high sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a 20 kPa cutoff. For severe portal hypertension (SPH), LSM had a sensitivity of 81% and specificity of 85% at 25 kPa. Combining LSM with platelet count resulted in a sensitivity of 97% but lower specificity (41%) for CSPH. Spleen stiffness measurement (SSM) also showed good diagnostic performance with a sensitivity of 89% and specificity of 75% for CSPH.Conclusions: Non-invasive tests, particularly LSM and SSM, show promise in diagnosing portal hypertension and variceal bleeding in NAFLD/MASLD cirrhosis. These methods offer high sensitivity, especially in combination, supporting their use in clinical settings to potentially reduce the need for invasive procedures. Future research should aim to standardize protocols and explore additional biomarkers to further enhance diagnostic accuracy.

    Keywords: Non-alcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), portal hypertension, Variceal bleeding, Non-invasive tests, liver stiffness measurement (LSM), Transient elastography, Spleen stiffness measurement (SSM)

    Received: 04 Jul 2024; Accepted: 15 Nov 2024.

    Copyright: © 2024 Shanka, Nigatu and Pavlov. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Nebyu Yonas Shanka, Department of Postgraduate and Doctoral Studies, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.