Noninvasive Tests of Liver Fibrosis and Their Combination in NAFLD: From Selected Patients to Real-Life Populations

Nonalcoholic fatty liver disease (NAFLD) has become extremely common, now affecting 25% of the worldwide population. All physicians, regardless of their specialty, are seeing NAFLD patients in their daily clinical practice, and all are challenged by the identification of the small subgroup having an advanced form of the disease. As with the other causes of chronic liver disease, it is now well established that liver fibrosis is the main predictor of the prognosis in NAFLD, justifying the interest in diagnosing fibrosis. Because it is not conceivable to perform liver biopsy (currently the best reference, albeit imperfect, for liver fibrosis evaluation) in large populations, noninvasive testing represents an attractive option for the diagnosis and screening of NAFLD patients with advanced liver disease in need of specialized management. The noninvasive tests currently available are mainly represented by blood tests, either simple blood tests combining common indirect markers of liver fibrosis or specialized blood tests, including direct markers of liver fibrogenesis and fibrolysis, and elastography devices. This article is protected by copyright. All rights reserved

Patatin-like phospholipase domain-containing protein 3 and Liver Disease: Opportunities to Unravel Mechanisms Underlying Statistical Associations

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Controlled attenuation parameter (CAP): a new device for fast evaluation of liver fat?

International audienc

Noninvasive diagnosis of liver fibrosis in NAFLD: Tips tricks

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent, affecting 25% of the general population. Liver fibrosis must be accurately evaluated in NAFLD to determine the severity of the disease and establish patient management. We present the case of a patient with diabetes showing minimal perturbations of liver function tests, but for whom a simple blood fibrosis test suggested the presence of advanced liver fibrosis. The patient was referred to a hepatologist who confirmed the diagnosis using a specialized blood test and transient elastography. Thereafter, a liver biopsy was performed and pathology was positive for cirrhosis. An upper gastrointestinal endoscopy showed no gastrointestinal varices. Simple blood fibrosis tests are very attractive for the first-line evaluation of liver fibrosis by non-specialists in the large populations of NAFLD and diabetic patients, as they are inexpensive, easy to perform, and accurate for the exclusion of advanced liver fibrosis. Non-specialists must however use them appropriately to avoid unnecessary over-referral to hepatologists. These latter can confirm the diagnosis of advanced liver fibrosis via agreement between a specialized blood test and liver elastography. In addition to the diagnosis of liver fibrosis, noninvasive tests are now recommended for the screening of gastrointestinal varices at risk of bleeding. Liver elastography must be interpreted by a specialist because the choice of the probe, the quality of the examination, and many conditions other than liver fibrosis can influence the examination and create a risk of false positives. Noninvasive tests of liver fibrosis have enabled exciting possibilities for widespread screening of advanced forms of chronic liver diseases. This will become particularly relevant in NAFLD when drugs currently in therapeutic trials become available in the next few years

Clinical interpretation of Fibroscan® results: a real challenge

International audienc

Case-finding strategies in non-alcoholic fatty liver disease

Among the large population of patients with non-alcoholic fatty liver disease (NAFLD), identifying those with advanced disease remains challenging. Many patients are diagnosed late, following the development of liver-related complications, leading to poor clinical outcomes. Accumulating evidence suggests that using non-invasive tests for liver fibrosis in patients with metabolic risk factors improves the detection of patients in need of specialised management and is cost-effective. Because of the vast number of patients requiring evaluation, the active participation of general practitioners and physicians who manage patients with metabolic disorders, such as diabetologists, is crucial; this calls for the increased awareness of NAFLD beyond liver clinics. Non-invasive case-finding strategies will need to be further validated and generalised for upcoming drug therapies to have the required impact on the worldwide burden of NAFLD