Non-invasive assessment of liver fibrosis in chronic liver diseases: Implementation in clinical practice and decisional algorithms
Open Access
- 1 January 2009
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 15 (18), 2190-2203
- https://doi.org/10.3748/wjg.15.2190
Abstract
Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications, including decompensation, bleeding and liver cancer. Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease. Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis, while cirrhosis requires a specific follow-up including screening for esophageal varices and hepatocellular carcinoma. Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive, costly and prone to sampling errors. Recently, blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis. However, there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available. This is due to an unsatisfactory accuracy for some of them, and to an incomplete validation for others. Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined. Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.Keywords
This publication has 108 references indexed in Scilit:
- Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non‐invasive laboratory testsAlimentary Pharmacology & Therapeutics, 2008
- Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver diseaseHepatology, 2008
- Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta-AnalysisGastroenterology, 2008
- Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European Liver Fibrosis Panel and exploring simple markersHepatology, 2007
- Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver diseaseGut, 2007
- FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotestHepatology, 2007
- Fibroindex, a practical index for predicting significant fibrosis in patients with chronic hepatitis CHepatology, 2007
- Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis CHepatology, 2004
- Sampling variability of liver fibrosis in chronic hepatitis CHepatology, 2003
- Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying diseaseHepatology, 1999