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Abstract Details
Population screening for liver fibrosis: Toward early diagnosis and intervention for chronic liver diseases
Hepatology. 2022 Jan;75(1):219-228. doi: 10.1002/hep.32163. Epub 2021 Dec 10.
1Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain.
2August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain.
3Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.
4Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
5Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
6Université de Paris, Paris, France.
7Inserm UMR 1149, Centre de Recherche Sur L'inflammation, Paris, France.
8Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
9Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany.
10Health Sciences, Hannover Medical School, Hannover, Germany.
11Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
12Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
13Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
14Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Diego, La Jolla, California, USA.
15Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital and Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
16USR Metropolitana Nord, IDIAP Jordi Gol, Catalan Health Institute, Mataró, Spain.
17Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
18Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
19Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
20Universitat Autònoma de Barcelona, Barcelona, Spain.
21UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK.
22Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
23NIHR Nottingham Biomedical Research Center, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
24Unit of Internal Medicine and Hepatology, Department of Medicine, University-Teaching Hospital of Padova, Veneto, Italy.
25Liver Unit, Hospital Germans Trias i Pujol, Badalona, Spain.
26Liver Section, Gastroenterology Department, Department of Medicine, Hospital del Mar, Barcelona, Spain.
27Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
28School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
29Clinical Trial Unit, Hospital Clínic, Barcelona, Spain.
30Department of Pathology, Center of Biomedical Diagnosis. Hospital Cínic, Barcelona, Spain.
31Unité d'Hépatologie, Hôpital Avicenne, Université Paris, Bobigny, France.
32European Association for the Study of the Liver, Geneva, Switzerland.
33National Institute for Health Research Biomedical Research Center at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.
Abstract
Cirrhosis, highly prevalent worldwide, develops after years of hepatic inflammation triggering progressive fibrosis. Currently, the main etiologies of cirrhosis are non-alcoholic fatty liver disease and alcohol-related liver disease, although chronic hepatitis B and C infections are still major etiological factors in some areas of the world. Recent studies have shown that liver fibrosis can be assessed with relatively high accuracy noninvasively by serological tests, transient elastography, and radiological methods. These modalities may be utilized for screening for liver fibrosis in at-risk populations. Thus far, a limited number of population-based studies using noninvasive tests in different areas of the world indicate that a significant percentage of subjects without known liver disease (around 5% in general populations and a higher rate -18% to 27%-in populations with risk factors for liver disease) have significant undetected liver fibrosis or established cirrhosis. Larger international studies are required to show the harms and benefits before concluding that screening for liver fibrosis should be applied to populations at risk for chronic liver diseases. Screening for liver fibrosis has the potential for changing the current approach from diagnosing chronic liver diseases late when patients have already developed complications of cirrhosis to diagnosing liver fibrosis in asymptomatic subjects providing the opportunity of preventing disease progression.