Diagnosis of non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis: Non‐invasive tests are enough

Abstract

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.

 

KEYWORDS
fibrosis, liver stiffness, nonalcoholic fatty liver disease, non‐invasive, serum biomarkers, transient elastography

 

About Speaker

Laurent CASTERA

MD, PhD

France

City: Paris

Institution: University of Paris-VII (Hôpital Beaujon, Clichy)

Contact: laurent.castera@bjn.aphp.fr


Biography of Laurent CASTERA

Laurent Castera (MD, PhD) received his Medical degree from the University of Paris-VI in 1993 and his PhD from University of Paris-XII in 2007. He currently works as Senior Consultant in Hepatology in the Department of Hepatology at the University of Paris-VII (Hôpital Beaujon, Clichy). His research interests focus on non-invasive methods for liver fibrosis assessment, particularly transient elastography, viral hepatitis and hepatocellular carcinoma. He has published more than 150 papers in international peer reviewed journals and also serves on the editorial boards of the Journal of Hepatology, Gut and Liver International. He has been the chairman of the EASL-ALEH Clinical Practice Guidelines on the use of non-invasive tests, published in 2015 in the Journal of Hepatology. He has been a member of the Scientific Committee of the United European Gastroenterology (UEG) from 2011 to 2013. He joined the EASL Governing Board in 2012 and currently serves as EASL Secretary General since April 2015.

View more