July 2025 - Mathias Jachs

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DDr. Mathias Jachs

MedUni Wien RESEARCHER OF THE MONTH July 2025

Clinically significant portal hypertension (CSPH) is the main driver of morbidity and mortality in patients with advanced chronic liver disease (ACLD). Early detection of CSPH facilitates prophylactic treatment that can prevent potentially life-threatening complications, i.e., variceal hemorrhage or ascites. Until recently, the diagnosis of CSPH could only be made during (minimally) invasive measurement blood pressure in the liver vein (“hepatic venous pressure gradient”). The recently introduced non-invasive liver stiffness measurement (LSM) via transient elastography correlates well with the invasively assessed portal pressure. However, in some patients, most importantly in obese patients, LSM alone associates with suboptimal diagnostic utility for CSPH. In their recently published study, Mathias Jachs and coauthors showed that the consideration of spleen stiffness measurement (SSM) in addition to LSM, body mass index and platelet count improves the diagnostic accuracy of non-invasive models for CSPH, thereby overcoming previous limitations. The study’s results may be considered the novel gold standard for the non-invasive diagnosis of CSPH and are prone to influencing the upcoming revised recommendations regarding CSPH diagnosis (“Baveno VIII Consensus”).

Selected Literature

1. Jachs M, Reiberger T. Prevention of Variceal Bleeding and Rebleeding by Nonselective Beta-Blockers: A Tailored Approach. Clin Liver Dis 2021;25:311-326.
2. Jachs M, Odriozola A, Turon F, et al. Spleen stiffness measurement by vibration-controlled transient elastography at 100 Hz for non-invasive predicted diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a modelling study. Lancet Gastroenterol Hepatol 2024;9(12):1111-1120.
3. Jachs M, Hartl L, Schaufler D, et al. Amelioration of systemic inflammation in advanced chronic liver disease upon beta-blocker therapy translates into improved clinical outcomes. Gut 2021;70:1758-1767.
4. Jachs M, Hartl L, Simbrunner B, et al. Carvedilol Achieves Higher Hemodynamic Response and Lower Rebleeding Rates Than Propranolol in Secondary Prophylaxis. Clin Gastroenterol Hepatol 2023;21:2318-2326.e2317.
5. Jachs M* , Hartl L *, Simbrunner B, et al. The Sequential Application of Baveno VII Criteria and VITRO Score Improves Diagnosis of Clinically Significant Portal Hypertension. Clin Gastroenterol Hepatol 2023;21:1854-1863.e1810. (* shared first authorship)
6. Jachs M, Hartl L, Simbrunner B, et al. Decreasing von Willebrand Factor Levels Upon Nonselective Beta Blocker Therapy Indicate a Decreased Risk of Further Decompensation, Acute-on-chronic Liver Failure, and Death. Clin Gastroenterol Hepatol 2022;20:1362-1373.
7. Jachs M, Hartl L, Simbrunner B, et al. Prognostic performance of non-invasive tests for portal hypertension is comparable to that of hepatic venous pressure gradient. J Hepatol 2024;80:744-752.
8. Paternostro R*, Jachs M*, Hartl L, et al. Diabetes impairs the haemodynamic response to non-selective betablockers in compensated cirrhosis and predisposes to hepatic decompensation. Aliment Pharmacol Ther 2023;58:805-813. (* shared first authorship)
9. Jachs M, Binter T, Schmidbauer C, et al. Hepatitis D virus (HDV) prevalence in Austria is low but causes considerable morbidity due to fast progression to cirrhosis. United European Gastroenterol J 2021;9:1119-1127.
10. Jachs M, Hartl L, Bauer D, et al. Long-Term Outcome of HBV-Infected Patients with Clinically Significant Portal Hypertension Achieving Viral Suppression. J Pers Med 2022;12:239.
11. Jachs M, Panzer M, Hartl L, et al. Long-term follow-up of patients discontinuing bulevirtide treatment upon long-term HDV-RNA suppression. JHEP Rep 2023;5:100751.
12. Jachs M* , Sandmann L* , Hartl L, et al. Validation of Baveno VII criteria and other non-invasive diagnostic algorithms for clinically significant portal hypertension in hepatitis delta. J Hepatol 2024;81:248-257. (* shared first authorship)
13. Jachs M, Sauberer R, Stiegler A, et al. Eligibility for antiviral therapy and treatment uptake in chronic hepatitis B patients referred to a European tertiary care center. United European Gastroenterol J 2023;11:293-304.
14. Jachs M, Schwarz C, Panzer M, et al. Response-guided long-term treatment of chronic hepatitis D patients with bulevirtide-results of a "real world" study. Aliment Pharmacol Ther 2022;56:144-154.
15. Bernhard J, Schwarz M, Balcar L, et al. Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center. Sci Rep 2024;14:25921.
16. Dietz-Fricke C* , Degasperi E* , Jachs M* , et al. Safety and efficacy of off-label bulevirtide monotherapy in patients with HDV with decompensated Child-B cirrhosis-A real-world case series. Hepatology 2024;80:664-673. (* shared first authorship)