Includes References

The past years have witnessed an enormous advancement in all areas of hepatology,
from molecular pathophysiology to diagnostic techniques and therapy, to the point
that we have now effective therapies for most liver diseases and noninvasive diagnostic tests are creating new gold standards for diagnosis that before required difficult and demanding invasive techniques.
These changes are paramount most especially in the diagnosis of cirrhosis and
portal hypertension. We come from an era when cirrhosis was diagnosed based on
liver biopsy to one when pathologists prefer to use the term “advanced chronic liver
disease” instead of “cirrhosis,” thus underlining the dynamic nature of disease process. In this scenario, different disease stages are better defined on the basis of clinical, imaging, and hemodynamic characteristics than by the biopsy findings that
correlate poorly with patient outcome. This is well illustrated by the fact that with
similar liver biopsy findings, patient prognosis can be very good (as exemplified by
the compensated patient without portal hypertension) or extremely poor (as in the
case of the decompensated patient with multiple complications).
The above considerations emphasize one of the major requirements in modern
medicine, that is, diagnostic tests should be able to inform on prognosis, therefore
providing the basis for both risk stratification at the time of diagnosis and personalizing treatment.
This approach has been used to devise this book that reviews the more recent
advances in the diagnostic methods for cirrhosis, the main complication of portal
hypertension, and non-cirrhotic causes of portal hypertension. We are making special emphasis on new noninvasive methods and on the use of these tests in the different stages of cirrhosis and different complications of portal hypertension. After
being part of the standard of care for the adult population, noninvasive diagnostic
methods are increasingly used in the pediatric population with cirrhosis and/or portal hypertension, and this aspect as well as the specificities of diagnostics in Western
and Eastern countries is taken into account.
Our aim is to offer to the general hepatologists and hepatologists in training the
current state of the art regarding the many different techniques available and under
development for clinical decision making. We hope the reader will find in the different chapters of this book—all written by well-known opinion leaders in their
fields—a concise but comprehensive and updated, clinically focused guide to
answer difficult questions, such as when to think about rare causes of non-cirrhotic portal hypertension (e.g., long-lasting porto-sinusoidal disease), when to start endoscopic surveillance in a given patient, or when to shift from a completely noninvasive assessment to an invasive measurement of HVPG in different clinical scenarios
(e.g., sustained virological response after treatment with direct-acting antivirals).
We would like to acknowledge the commitment and efforts of all the authors
from different disciplines (hepatology, endoscopy, radiology, pathology) and from
the different areas of the world that have contributed to this book. They provide an
outstanding example of what interdisciplinary collaboration can bring into the complex field of hepatology.
We hope that this book will be helpful for hepatologists and physicians interested
in liver diseases in order to select the most appropriate diagnostic methods for their
patients with cirrhosis and/or portal hypertension.