Cerrito L, Ainora ME, Nicoletti A, Garcovich M, Riccardi L, Pompili M, Gasbarrini A, Zocco MA. Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals. World J Hepatol 2021; 13(11): 1663-1676 [PMID: 34904036 DOI: 10.4254/wjh.v13.i11.1663]
Corresponding Author of This Article
Maria Assunta Zocco, MD, PhD, Doctor, Senior Researcher, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome (Italy), Largo Agostino Gemelli 8, Rome 00168, Italy.mariaazocco@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Nov 27, 2021; 13(11): 1663-1676 Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1663
Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals
Lucia Cerrito, Maria Elena Ainora, Alberto Nicoletti, Matteo Garcovich, Laura Riccardi, Maurizio Pompili, Antonio Gasbarrini, Maria Assunta Zocco
Lucia Cerrito, Maria Elena Ainora, Alberto Nicoletti, Matteo Garcovich, Laura Riccardi, Maurizio Pompili, Antonio Gasbarrini, Maria Assunta Zocco, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome (Italy), Rome 00168, Italy
Author contributions: Cerrito L, Ainora ME and Zocco MA designed the review and revised the manuscript; Cerrito L and Nicoletti A drafted the manuscript; Cerrito L, Garcovich M and Riccardi L performed the scientific literature research; Pompili M and Gasbarrini A revised the manuscript critically for intellectual content; all authors have approved the final version.
Conflict-of-interest statement: Nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Assunta Zocco, MD, PhD, Doctor, Senior Researcher, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome (Italy), Largo Agostino Gemelli 8, Rome 00168, Italy.mariaazocco@hotmail.com
Received: March 31, 2021 Peer-review started: March 31, 2021 First decision: June 23, 2021 Revised: July 8, 2021 Accepted: August 17, 2021 Article in press: August 17, 2021 Published online: November 27, 2021
Abstract
Chronic inflammation due to hepatitis C virus (HCV) infection leads to liver fibrosis and rearrangement of liver tissue, which is responsible for the development of portal hypertension (PH) and hepatocellular carcinoma (HCC). The advent of direct-acting antiviral drugs has revolutionized the natural history of HCV infection, providing an overall eradication rate of over 90%. Despite a significant decrease after sustained virological response (SVR), the rate of HCC and liver-related complications is not completely eliminated in patients with advanced liver disease. Although the reasons are still unclear, cirrhosis itself has a residual risk for the development of HCC and other PH-related complications. Ultrasound elastography is a recently developed non-invasive technique for the assessment of liver fibrosis. Following the achievement of SVR, liver stiffness (LS) usually decreases, as a consequence of reduced inflammation and, possibly, fibrosis. Recent studies emphasized the application of LS assessment in the management of patients with SVR in order to define the risk for developing the complications of chronic liver disease (functional decompensation, gastrointestinal bleeding, HCC) and to optimize long-term prognostic outcomes in clinical practice.
Core Tip: Direct-acting antiviral agents lead to hepatitis C virus eradication and to the regression of liver inflammation. However, they do not eliminate the risk of possible portal hypertension-related complications and hepatocellular carcinoma (HCC), increasing the necessity for post-sustained virological response surveillance and the development of non-invasive predictive models to detect the categories of patients requiring more intensive follow-up. Many studies reported a significant reduction in liver fibrosis markers after treatment with direct-acting antiviral drugs. Ultrasound elastography is gaining growing importance as a predictive element in the assessment of the risk of developing esophageal varices or gastrointestinal bleeding, liver functional decompensation and HCC.
