Non‐alcoholic fatty liver disease is a major cause of liver disease worldwide and the most common liver disorder in Western countries, affecting around 25% of the general population. Fibrosis is the major long‐term histological prognostic criteria of this disease. Liver biopsy cannot be realistically performed in such a huge population and, moreover, has well‐known limitations (invasiveness, rare but potentially life‐threatening complications and sampling variability). Over the past decade, there has been a growing interest in alternative novel strategies for the non‐invasive evaluation of fibrosis. These tests rely on two different but complementary approaches: either measuring the levels of serum biomarkers, or liver stiffness, using ultrasound‐based elastography techniques. In non‐alcoholic fatty liver disease patients, transient elastography, FIB‐4 and the non‐alcoholic fatty liver disease fibrosis score are the best validated tests, with summary area under the ROC curve values for diagnosing severe fibrosis‐cirrhosis of 0.88, 0.84 and 0.84 respectively. They can also identify the subgroup of non‐alcoholic fatty liver disease patients at high risk of developing liver‐related complications and death. As a result, non‐invasive tests are now widely used in routine clinical practice and included in national and international guidelines. The next step is the use of non‐invasive tests as first‐line tools for screening non‐alcoholic fatty liver disease in the general population to identify patients who should be referred to specialized centres.
fibrosis, liver stiffness, nonalcoholic fatty liver disease, non‐invasive, serum biomarkers, transient elastography