A fourth dimension in decision making in hepatology

Abstract

Today, the assessment of liver function in patients suffering from acute or chronic liver disease is based on liver biopsy and blood tests including synthetic function, liver enzymes and viral load, most of which provide only circumstantial evidence as to the degree of hepatic impairment. Most of these tests lack the degree of sensitivity to be useful for follow-up of these patients at the frequency that is needed for decision making in clinical hepatology. Accurate assessment of liver function is essential to determine both short- and long-term prognosis, and for making decisions about liver and non-liver surgery, TIPS, chemoembolization or radiofrequency ablation in patients with chronic liver disease. Liver function tests can serve as the basis for accurate decision-making regarding the need for liver transplantation in the setting of acute failure or in patients with chronic liver disease. The liver metabolic breath test relies on measuring exhaled (13) C tagged methacetin, which is metabolized only by the liver. Measuring this liver-specific substrate by means of molecular correlation spectroscopy is a rapid, non-invasive method for assessing liver function at the point-of-care. The (13) C methacetin breath test (MBT) is a powerful tool to aid clinical hepatologists in bedside decision-making. Our recent findings regarding the ability of point-of-care (13) C MBT to assess the hepatic functional reserve in patients with acute and chronic liver disease are reviewed along with suggested treatment algorithms for common liver disorders.

13C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations

“…An increase in the number of relevant scientific papers indicates that, from among the tests dedicated to assess the activity of cytochrome P450, known as the microsomal breath tests, the 13 C-MBT has lately taken the lead. Accordingly, Yaron Ilan in his very recent review [36] provides evidence-based arguments that the 13 C-MBT is a powerful tool to aid hepatologists in bedside decision making.…”

Potential use of metabolic breath tests to assess liver disease and prognosis: has the time arrived for routine use in the clinic?

“…The PDR refers to the rate at which the 13 C substrate is metabolized, and is derived from the change in the 13 C/ 12 C ratio in real time . Several clinical studies have shown that the continuous MBT can serve as a method to determine liver function in various clinical settings …”

An Update on 13C-Breath Tests: The Transition to Acceptability into Clinical Practice

“…[119][120][121][122][123][124][125][126] Methacetin is rapidly metabolized primarily by CYP1A2 in the liver and in small doses lacks toxicity making it an ideal substrate for evaluating cytochrome P450 enzyme activity.…”