R. Pozzi

Feasibility and reproducibility of spleen transient elastography and its role in combination with liver transient elastography for predicting the severity of chronic viral hepatitis

Liver transient elastography (L‐TE) is a reliable, noninvasive predictor of disease severity in chronic liver disease of viral aetiology (CLD). Owing to the relationships among severity of CLD, portal hypertension and spleen involvement, the assessment of splenic stiffness (S‐TE) may have an added value in staging CLD. Of 132 CLD patients of viral aetiology, 48 with myeloproliferative disorders (MD) and 64 healthy volunteers (HV), were concurrently investigated by both L‐TE and S‐TE. Liver disease severity was staged by liver biopsy (LB; Metavir) taken concurrently with TE examination and upper gastrointestinal tract endoscopy for gastro‐oesophageal varices. The S‐TE inter‐observer agreement was analysed by an intra‐class correlation coefficient (ICC); L‐TE and S‐TE accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis assessed the independent effect of L‐TE and S‐TE as predictors of hepatic fibrosis stage. S‐TE failed in 22 CLD (16.6%), 12 (25%) MD and 12 (18%) HV. In the three groups, the ICC was 0.89 (0.84–0.92), 0.90 (0.85–0.94) and 0.86(0.80–0.91), respectively. In the CLD group, L‐TE and S‐TE independently predicted significant fibrosis (OR 5.2 and 4.6) and cirrhosis (OR 7.8 and 9.1), but at variance from L‐TE, S‐TE was independent from liver necroinflammation and steatosis. The NPV of S‐TE for gastro‐oesophageal varices was 100% using a 48 kPa cut‐off. In CLD, spleen stiffness alone or in combination with hepatic stiffness can be reliably and reproducibly assessed by TE with the added value of improving the noninvasive diagnosis of severe liver disease and excluding the presence of oesophageal varices.

Bowel ultrasound imaging in patients with cystic fibrosis: Relationship with clinical symptoms and CFTR genotype

BACKGROUND Ultrasound imaging is used to assess bowel abnormalities in gastrointestinal diseases. We aimed to assess the rate of predefined bowel ultrasound signs and their relationship with gastrointestinal symptoms and the cystic fibrosis transmembrane conductance regulator (CFTR) genotype in cystic fibrosis patients in regular follow-up. METHODS Prospective study of 70 consecutive patients with cystic fibrosis and 45 controls who underwent abdominal ultrasound; pertinent findings were related to gastrointestinal symptoms and, in cystic fibrosis patients, to pancreatic status, malabsorption degree, lipase intake, CFTR genotype (classified as severe or mild against functional class of CFTR mutations). RESULTS 96% patients showed at least one abnormal bowel ultrasound sign. Most frequent signs were lymph node enlargement (64%), bowel loop dilatation (55%), thick corpuscular intraluminal content (49%), bowel wall hypervascularization (26%), thickened bowel wall (22%) and intussusception (17%). Patients with recurrent abdominal pain showed more bowel wall hypervascularization than patients without recurrent pain (47% vs. 19%, respectively; p = 0.02) and intussusception (58% vs. 17%, respectively; p < 0.01). Genotype was not associated to specific bowel ultrasound signs. Patients with bowel loop intussusception showed greater lipase intake than those without intussusception (8.118 ± 2.083 vs. 5.994 ± 4.187, respectively; p < 0.01). CONCLUSION Cystic fibrosis patients present a higher rate of bowel ultrasound abnormalities than controls. Bowel ultrasound abnormalities are associated with abdominal symptoms.

1369 TRANSIENT ELASTOGRAPHY IN ACUTE ALCOHOLIC HEPATITIS AND DURING FOLLOW UP: A SINGLE-INSTITUTION EXPERIENCE

(p < 0.0001; CI = 7.42, 20.58; % of events correctly reclassified = 39.47%), respectively. The combination of uEtG with CDT and AUDIT-c showed a better prediction rate of alcohol consumption when compared to the combination of CDT and AUDIT-c and the combination of CDT, AUDIT-c, MCV, GGT and AST/ALT ratio, with a NRI of 18.69% (p < 0.0001; CI = 11.31, 26.08; % of events correctly reclassified = 46.51%) and 36% (p < 0.0001; CI = 26.93, 45.07; % of events correctly reclassified = 16.27%; % of non events correctly reclassified = 48.43%), respectively. Conclusions: uEtG represents a sensitive, specific and accurate marker of alcohol consumption in LTCs and LTRs, and improves detection of alcohol consumption in these patients. Hence, it should be routinely used in the assessment of LTCs and LTRs.