Non-invasive tools for compensate d advance d chronic liver disease and portal hypertension after Baveno VII-an update

Non-invasive tests (NITs) and liver stiffness measurement (LSM) in particular, have entered clinical prac-tice over 20 years ago as point-of-care tests to diagnose liver fibrosis in patients with compensated chronic liver disease. Since then, NITs use has evolved thanks to a large number of studies in all major etiologies of liver disease, and they have become important tools to stratify the risk of portal hyperten-sion and liver-related events. The Baveno VII consensus workshop provided several novel recommenda-tions regarding the use of well-established and novel NITs in the specific setting of portal hypertension screening, diagnosis and follow-up. The Baveno VII expert panels paid special attention to summarizing the existing data into simple clinical rules able to guide clinicians in their practice. The rule of five for LSM is a tool to stratify the risk of liver-related events, and LSM alone or in combination with platelet count, can be used now to rule-in and rule-out compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension, as well as to rule-out high-risk varices. Use of NITs in obese subjects with non-alcoholic fatty liver disease (NAFLD) and patients with viral hepatitis C that has been successfully treated, require specific knowledge. This review will update the reader on these aspects.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

Non-invasive tests (NITs) and liver stiffness measurement (LSM) have been used for over 20 years in clinical practice to diagnose liver fibrosis in patients with compensated chronic liver disease. They have evolved to become important tools in stratifying the risk of portal hypertension and liver-related events. The Baveno VII consensus workshop provided novel recommendations on the use of well-established and novel NITs in the screening, diagnosis, and follow-up of portal hypertension.