Preventive Approaches in Chronic Liver Diseases Part II: Compensated Liver Cirrhosis

INTRODUCTION Liver cirrhosis (LC) is an irreversible stage of chronic liver disease progression. Depending on the etiology of the liver disease, chronic liver disease could take up to 20–30 years to develop into cirrhosis. Hepatitis C virus (HCV) is the most frequent cause of LC and the leading indication for liver transplantation (1). LC is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules (2). It is the fifth cause of death, in the United States, for individuals between ages 45-to-54 (3). The gold standard test to diagnose cirrhosis is liver biopsy. It is far from being a perfect test given its invasive nature and only fair sensitivity for advanced liver fibrosis. As an invasive procedure, it has complications such as prolonged hospital stay (about 1%–5% of cases) and mortality rate (about 0.1%–0.01%) (4). There has been a persistent search for an alternative method to diagnose liver fibrosis, but these have not been able to achieve wide clinical acceptance. Some approaches are based on imaging modalities to observe the changes in the liver per se. These techniques have not shown promising results regarding differentiation between early versus late liver fibrosis (5). Other methods used for the diagnosis of liver fibrosis include the non-invasive biochemical fibrosis markers. There has been a search for a perfect marker that could accurately reflect fibrosis in patient with variety of liver diseases. Some are based on matrix degradation products (N-terminal propeptide of type III collagen, collagen IV, prolyl hydroxylase, etc.) which have shown to be non-specific (6). Some researchers have focused their investigation on the combination of laboratory tests and patient characteristics (like age and sex). These have shown to be non-reproducible. Rosenberg, et al used a combination of nine surrogate markers for liver fibrosis including age, hyaluronic acid and A SPECIAL THREE-PART ARTICLE