Title Reduction of liver stiffness following resolution of acute flares of chronic hepatitis B

Background Measuring liver stiffness is becoming more popular as a non-invasive tool for assessing liver fibrosis. Aim To assess the effect of severe hepatitis B flare on liver stiffness and determine factors that correlate with liver stiffness measurements. Methods Twenty-nine patients with severe hepatitis B flare (ALT [ 10 9 upper limit of normal) were followed up for 1 year. Serial transient elastography was performed at the time of flare, 3–6, and 12 months after flare. Results At the time of flare, the median liver stiffness was 16.8 kPa, with no patients having normal liver stiffness (\6 kPa). There was a significant decrease in liver stiffness from baseline to 3–6 months (16.8 vs. 7.9 kPa, respectively, P \ 0.001), and a further smaller decline from 3–6 to 12 months (7.9 vs. 6.9 kPa, respectively, P = 0.039). By 12 months, 10 (34%) had normalized their liver stiffness. Baseline parameters which correlated with liver stiffness include bilirubin, ALT, albumin, prothrombin time and platelet levels (all P \ 0.05). Conclusion Liver stiffness was increased in patients with severe hepatitis B flares, with return to near normal levels by 6 months. Transient elastography for proper assessment of liver fibrosis should be performed at least 6 months after flare.