Author information
1
Department of Hepatology, Hôpital Beaujon, INSERM UMR 1149, University of Paris-VII, Clichy, France. Electronic address: laurent.castera@bjn.aphp.fr.
2
Department of Internal Medicine 1, Division of Gastroenterology, Hepatology, Goethe University Hospital, Frankfurt, Germany.
3
NAFLD Research center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, USA.
Abstract
Nonalcoholic fatty liver disease (NAFLD) is estimated to afflict approximately 1 billion individuals worldwide. In a subset of NAFLD patients, who have the progressive form of NAFLD termed as nonalcoholic steatohepatitis (NASH), it can progress to advanced fibrosis, cirrhosis, hepatocellular carcinoma and liver-related morbidity and mortality. NASH is typically characterized by a specific pattern on liver histology, including steatosis, lobular inflammation, ballooning with or without peri-sinusoidal fibrosis. Thus, key issues in NAFLD patients are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. Until now, liver biopsy has been the gold standard for identifying these two critical endpoints but has well known limitations including invasiveness, rare but potentially life-threatening complications, poor acceptability, sampling variability and cost. Furthermore, due to the epidemic proportion of individuals with NAFLD worldwide, liver biopsy evaluation is impractical and non-invasive assessment for the diagnosis of NASH and fibrosis is needed. Although much of the work remains to be done in establishing cost-effective strategies for screening for NASH, advanced fibrosis and cirrhosis, in this review, we summarize the current state of the non-invasive assessment of liver disease in NAFLD, and we provide an expert synthesis of how these non-invasive tools could be utilized in clinical practice. Finally, we also list the key areas of research priorities in this area to move forward clinical practice.