Advances in diagnosis of chronic liver diseases in pediatric patients
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REVIEW ARTICLE
Advances in diagnosis of chronic liver diseases in pediatric patients Lucija Ruzman1 · Ivana Mikolasevic2 · Kristina Baraba Dekanic3 · Sandra Milic2 · Goran Palcevski3 Received: 1 May 2018 / Accepted: 25 September 2018 © Children’s Hospital, Zhejiang University School of Medicine 2018
Abstract Background Chronic liver diseases (CLD) present important clinical problem in children with various age-dependent causes. Nonalcoholic fatty liver disease (NAFLD) with its increasing prevalence is a major problem with regard to its timely recognition and the need for long-term disease monitoring. At present, a perfect non-invasive method for the evaluation of liver fibrosis is not available. Methods A non-systematic literature search was performed to summarize the current knowledge about transient elastography (TE) with controlled attenuation parameter (CAP) in children with CLD. Ovid MEDLINE, Ovid EMBASE, Google scholar, and The Cochrane Library databases were searched for relevant articles evaluating TE in the pediatric population. Results Normal values of liver stiffness measurements (LSM) according to the age are given, as well as the advantages and disadvantages of the method. The utility of TE in specific liver disease in pediatric population is summarized. Conclusions TE with CAP is a valuable non-invasive method for the liver-damage assessment. Clinical interpretation of TE results should be made in parallel with the assessment of the patient’s demographics, disease etiology, and essential laboratory parameters. Keywords Child · Liver disease · Liver stiffness · Pediatric · Transient elastography
Introduction Chronic liver diseases (CLD) raise increasingly important clinical challenges in pediatric population with various agedependent causes. Biliary atresia and inherited syndromes of intrahepatic cholestasis (e.g., choledochal cysts, Alagille syndrome, and inherited progressive cholestatic syndromes) are the main causes of CLD with consequent cirrhosis in children [1]. Aside from biliary atresia, genetic and metabolic diseases are frequent causes of CLD in the first years of life. Chronic viral hepatitis C and B, autoimmune hepatitis, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12519-018-0197-8) contains supplementary material, which is available to authorized users. * Lucija Ruzman [email protected] 1
Pediatric Clinic, UHC Rijeka, Istarska 43, 51 000 Rijeka, Croatia
2
Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
3
Pediatric Clinic, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
cystic fibrosis, Wilson’s disease, and α1-antitrypsin deficiency are typical CLD in older children. The most common cause of CLD in children is nonalcoholic fatty liver disease (NAFLD) with a pooled mean prevalence of 7.6% in children overall and of 34% in children with obesity [2]. NAFLD is suspected when abnormal serum aminotransferases and obesity are present, supported by hyperechoic liver appearance (i.e., the d
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