Therapeutic Monitoring of Portal Pressure Lowering Drugs Using Liver Stiffness

Non-invasive assessment of liver stiffness (LS) is increasingly used to predict portal hypertension (PH) and esophageal varices with AUROCs ranging between 0.94 and 0.99 with cut-off values from 13 to 21 kPa. Additional assessment of spleen stiffness (SS) further increases prediction of PH and a SS >40 kPa is highly suggestive for significant PH. First experimental data in small animal models demonstrate that both LS and SS could be used to monitor the effectiveness of portal pressure-lowering drugs (metoprolol, udenafil, enalapril, carvedilol, and terlipressin) in a non-invasive manner. Prospective human data are still lacking, but there are first indications that a short-term decrease of LS and SS in response to interventions to treat PH is predicting a better outcome. In conclusion, LS and SS will play an increasing role in the management and prognostic evaluation of portal hypertension.