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Preventing & screening for hepatitis D

Specific liver tests – information for patients

Chronic hepatitis D can have serious and irreversible health consequences.1 In order to adequately monitor the course of the disease, a doctor, a specialist in hepato-gastroenterology, will perform targeted tests. In the following, we explain the different testing options.

Definition of the stage of liver fibrosis

WHAT IS FIBROSIS?

Hepatitis means an inflammation of the liver cells. If hepatitis D is not recognised and treated, the liver is permanently exposed to this inflammation. The body reacts to this by initially building up functionless connective tissue in the liver. This increased formation of connective tissue is called fibrosis.

Liver with hepatic fibrosis

If the inflammatory process progresses, more and more liver cells die, leaving behind scarred tissue. This scarring is called cirrhosis. Liver cirrhosis is a chronic disease that can lead to severe complications. Cirrhosis is characterised by a disorganisation of the liver architecture associated with persistent inflammation. This inflammation can be due to viral hepatitis, such as hepatitis D. Thus, contrary to popular belief, cirrhosis of the liver is not exclusively associated with excessive alcohol consumption.1

Liver with cirrhosis

WHICH EXAMINATIONS ARE CARRIED OUT?

Nowadays, most examinations are non-invasive. However, in some cases it is necessary to take a tissue sample from the liver.2

Non-invasive methods

Blood sample and abdominal ultrasound for detecting hepatic fibrosis in the liver

Various tests (FibroTest® or FibroMeter®) can be performed with a simple blood sample.3

Other non-invasive methods, so-called physical methods, make it possible to assess the condition of the liver.

- Abdominal ultrasound is a simple radiological examination that provides morphological information such as the size or general appearance of the liver.

- FibroScan® measures the stiffness of the liver, also known as liver elasticity.4 Liver stiffness can also be measured with an abdominal ultrasound machine. The more severe the damage to the liver, the stiffer the liver.

Liver biopsyIn a few special situations, your doctor may prescribe a liver biopsy. This is the most reliable way to assess the severity of the disease. A small piece of the liver is removed with a needle under local anaesthetic and examined under a microscope.5,6

Laboratory analysis

Laboratory analysis of this sample allows the degree of liver damage to be determined and can for instance be classified in the METAVIR score.7,8   

Assessment of the severity of cirrhosis

Child-Pugh score9,10

The progression of cirrhosis is assessed by the Child-Pugh score. This score is used to assess the severity of the disease and to establish a prognosis.9

The Child-Pugh score is used to uniformly describe and classify cirrhosis according to the severity of symptoms at different stages.

Finally, the MELD score (Model for End-Stage Liver Disease) is calculated in the advanced stages of chronic liver disease and is used to predict the vital prognosis of patients. This score, which is calculated from biological blood data, is used, among other things, to determine whether the patient can benefit from a liver transplant.11,12

References

  1. Deutsche Leberstiftung. Hepatitis D-Virus (HDV)/ Hepatitis D, delta.  https://www.deutscheleberstiftung.de/presse/pressemappe/lebererkrankungen/virushepatitis/hepatitis-d/. Juni 2020
  2. Das Gastroenterologie-Portal. Hepatitis D, Diagnose. http://dasgastroenterologieportal.de/Hepatitis_D.html. Juni 2020
  3. MSD MANUAL Ausgabe für medizinische Fachkreise. Hepatische Fibrose. https://www.msdmanuals.com/de-de/profi/erkrankungen-der-leber,-der-gallenblase-und-der-gallenwege/fibrose-und-zirrhose/hepatische-fibrose. Juni 2020.
  4. https://www.leber-ratgeber.de/die-leber/diagnose-einer-lebererkrankung-leber-ratgeber/index.html Juni 2020
  5. Gastroenterologische Gemeinschaftspraxis. Leberpunktion/ – biopsie. https://gastropraxis-osnabrueck.de/untersuchungen/leberpunktion-biopsie/. Juni 2020.
  6. Praktisch Arzt. Leberbiopsie. https://www.praktischarzt.de/untersuchungen/biopsie/leberbiopsie/. Juni 2020.
  7. Bedossa P, Poynard T. METAVIR cooperative study group. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-93.
  8. Hepatitis and more. Invasive Fiabrosediagnostik. https://www.hepatitisandmore.de/archiv/2012-1/invasive-fibrosediagnostik.shtml . Juni 2020
  9. Leberzirrhose. Child-Pugh-Score. https://leberzirrhose.de/child-pugh-kriterien/gclid=Cj0KCQjwoaz3BRDnARIsAF1RfLdW7eI4wkpypSWfTEL7Od1LeEWkwblGa_gd-3ZriGmDaYVUAJZiYXcaAsOTEALw_wcB. Juni 2020
  10. Child CG, Turcotte JG Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
  11. MD Calc. MELD Score. https://www.mdcalc.com/meld-score-model-end-stage-liver-disease-12-older. Juni 2020
  12. LADR. Model of end stage liver disease (MELD) Score. https://ladr.de/service/rechenprogramme/meld-score . Juni 2020