Assessing Portal Hypertension With Methacetin Breath Test

Study Overview
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Brief Summary
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This study will be used to train an algorithm using Methacetin breath test (MBT) measures and to select a cut-off to determine presence or absence of Clinically Significant Portal Hypertension (CSPH) as defined by Hepatic Venous Gradient Pressure (HVPG) ≥ 10mmHg,

Detailed Description
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The portal pressure leaving the liver is measured by using a balloon catheter before and after a wedge. The difference of the pressure between the wedge and the free is the hepatic venous pressure gradient. Methacetin breath test is hypothesized to also identify CSPH and the agreement to the reference standard (HVPG) will be assessed in this study.

Official Title
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Clinical Study of the BreathID® LF System to Train the Algorithm for the ¹³C-Methacetin Breath Test (MBT) in Assessment of Portal Hypertension in Patients With Compensated Liver Cirrhosis

Conditions
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Patients With Compensated Liver Cirrhosis

Intervention / Treatment
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* Device: Methacetin Breath Test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult men or women (>18 years of age) Known chronic liver disease with cirrhosis Europe: Indicated to undergo HVPG testing US: Consented for HVPG For patients treated with beta blockers: They have to be on a stable dose for at least 6 weeks prior to any study related tasks For patients who stopped their treatment with beta blockers: Their last dose should be at least 6 weeks prior to any study related tasks Exclusion Criteria: Decompensated cirrhosis as clinically defined by the presence of ascites, hepatic encephalopathy, variceal bleeding or hepatorenal syndrome Renal failure (creatinine > 2.5 mg/dl) Known acute renal tubular disease Known hypotension (Systolic Pressure <100mmHg) Hypocoagulablity defined as PT >6 and INR >2.3. Congestive heart failure (assessed clinically as NIHA >2) Known pulmonary hypertension (right ventricular systolic pressure > 45 mm Hg) Uncontrolled diabetes mellitus (HBA1C >9.5gr%) Concurrent prednisone or immunosuppressive treatment, if therapy and/or response to treatment are not stable for at least 3 months. Documented or suspected hepatocellular carcinoma Gastric bypass surgery or extensive small bowel resection Total parenteral nutrition Any organ transplant recipient Pregnant or breast feeding Allergy to acetaminophen and/or other related medications Documented drug-related concurrent hepatotoxicity or drug-related silent steatosis or drug-related fibrosis (e.g. amiodarone, methotrexate and tamoxifen) Uncontrolled malabsorption or diarrhea Documented non-cirrhotic PHT, partial / complete portal venous occlusion, hepatic venous occlusion, previous PHT surgery, or placement of a transjugular intrahepatic portosystemic shunt (TIPS) Primary or secondary biliary cirrhosis, primary or secondary sclerosing cholangitis, hepatic sarcoidosis, or other cholestatic disorders Subjects unable to perform the MBT within 7 days of HVPG procedure. Subject should not have taken any of the following for at least 48 hours prior to the breath test: Acyclovir , allopurinol, amiodarone, carbamazepine, cimetidine, ciprofloxacin, daidzein, (herbal) disulfiram, echinacea, enoxacin, famotidine, fluvoxamine, methoxsalen, mexiletine, montelukast, norfloxacin, phenylpropanolamine, phenytoin, propafenone, rifampin, terbinafine, ticlopidine, thiabendazole, verapamil, zileuton or oral contraceptives or any medication that might interfere with Methacetin metabolism or might affect CYP 1A2 Subject should not have taken amiodarone or statins within the last 30 days prior to the breath test or HVPG procedure

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Compensated cirrhotic patients<br>A methacetin breath test will be performed on patients who are undergoing the HVPG procedure due to their clinical indication of compensated cirrhosis. | Device: Methacetin Breath Test<br>* 13C labelled methacetin solution for breath test monitoring<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CSPH (Clinically Significant Portal Hypertension) | Clinically significant portal hypertension is defined as Hepatic Venous Pressure Gradient (HVPG)>=10mmHg, whereby the portal pressure leaving the liver is measured by using a balloon catheter before and after a wedge. The difference of the pressure between the wedge and the free is the hepatic venous pressure gradient. Methacetin breath test is hypothesized to also identify CSPH and the agreement to the reference standard (HVPG) will be assessed in this study. | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hepatic Venous Pressure Gradient (HVPG)>=12; Severe Portal Hypertension (SPH) | Hepatic Venous Pressure Gradient greater than 12 (SPH) is an indicator of bleeding varices. whereby the portal pressure leaving the liver is measured by using a balloon catheter before and after a wedge. The difference of the pressure between the wedge and the free is the hepatic venous pressure gradient. Methacetin breath test is hypothesized to also identify SPH and the agreement to the reference standard (HVPG) will be assessed in this study. | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MBT, CSPH, HVPG