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From: Cactus Jammies on 9 Nov 2008 14:47
From Hepatitis Central

October 27, 2008

Safer Than Liver Biopsy: A Simple Breath Test for HCV
A specially designed breath test has been found to be a safe and accurate
alternative to liver biopsy for determining the degree of inflammation and
fibrosis in patients with chronic Hepatitis C infection and normal ALT,
according to researchers from Jerusalem.

(13)C-methacetin Breath Test for Non-invasive Assessment of Liver Fibrosis
in Chronic Hepatitis C Patients


By Liz Highleyman

Over years or decades, chronic hepatitis C virus (HCV) infection can
progress to advanced liver disease including severe fibrosis, cirrhosis, and
hepatocellular carcinoma. Liver biopsy remains the "gold standard" for
assessing liver disease progression, but since the procedure is expensive,
uncomfortable, and carries a small risk of complications, researchers have
explored various non-invasive methods.

Several of these methods employ various blood biomarkers. Liver function
tests that measure alanine aminotransferase (ALT) and aspartate
aminotransferase (AST) indicate liver inflammation and may be a sign of
progressive liver damage, but as many as one-third of hepatitis C patients
with significant liver disease have persistently normal ALT.

As background, the authors noted that the test reflects hepatic microsomal
function and has been shown to correlate with liver fibrosis. Such tests
work on the principle that a damaged liver is unable to efficiently
metabolize various substances, which can be measured in the expelled breath.

The investigators tested 100 patients with untreated chronic HCV infection
along with 100 healthy HCV negative age- and sex-matched volunteers. The
(13)C-methacetin breath test was administered following ingestion of 75 mg
methacetin. All participants had undergone a liver biopsy within 12 months
of receiving the breath test.

Patients with a necroinflammatory grade <4 (based on Ishak score) were
defined as having low-level inflammation, while those with a grade > 4 were
defined as having high-level inflammation. Individuals with a histological
activity fibrosis stage < 2 were defined as having non-significant fibrosis,
while those > 2 were defined as having significant fibrosis.

Results

.. A proprietary algorithm used to differentiate liver inflammation in
chronic hepatitis C patients with normal ALT achieved an area under the
curve (AUC) of 0.90.

.. Setting a threshold on the point of best agreement, at 83%, resulted in
82% sensitivity and 84% specificity.

.. Applying another proprietary algorithm to differentiate patients with
non-significant or significant fibrosis, 67% of liver biopsies could have
been avoided by using the breath test.

.. This algorithm achieved an AUC of 0.92, with a sensitivity of 91% and a
specificity of 88%.

" There was no correlation between body mass index and breath test scores
for patients with the same histological score.

"The continuous BreathID (13)C-methacetin breath test is an accurate tool
for measuring the degree of inflammation and fibrosis in patients with
chronic HCV infection and normal ALT," the study authors concluded. "As
such, it may prove to be a powerful, noninvasive alternative to liver biopsy
in the management of this patient population."

10/24/08

Reference
G Lalazar, O Pappo, T Hershcovici, and others. A continuous (13)C methacetin
breath test for noninvasive assessment of intrahepatic inflammation and
fibrosis in patients with chronic HCV infection and normal ALT. Journal of
Viral Hepatitis 15(10): 716-728. October 2008.

---

URL for Article Source:
http://www.hivandhepatitis.com/hep_c/news/2008/102408_a.html

http://www.hepatitis-central.com/mt/archives/2008/10/simple_breath_t.html?eml=hepcen65



- cactus jammies


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