Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

J K Dowman, J W Tomlinson, P N Newsome, J K Dowman, J W Tomlinson, P N Newsome

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in Western countries. The development of non-alcoholic steatohepatitis (NASH) and fibrosis identifies an at-risk group with increased risk of cardiovascular and liver-related deaths. The identification and management of this at-risk group remains a clinical challenge.

Aim: To perform a systematic review of the established and emerging strategies for the diagnosis and staging of NAFLD.

Methods: Relevant research and review articles were identified by searching PubMed, MEDLINE and EMBASE.

Results: There has been a substantial development of non-invasive risk scores, biomarker panels and radiological modalities to identify at-risk patients with NAFLD without recourse to liver biopsy on a routine basis. These modalities and algorithms have improved significantly in their diagnosis and staging of fibrosis and NASH in patients with NAFLD, and will likely impact on the number of patients undergoing liver biopsy.

Conclusions: Staging for NAFLD can now be performed by a combination of radiological and laboratory techniques, greatly reducing the requirement for invasive liver biopsy.

© 2010 Blackwell Publishing Ltd.

Figures

Figure 1
Figure 1
Making the diagnosis of NAFLD.
Figure 2
Figure 2
Proposed algorithm for the work-up of a patient with NAFLD. Patients with a NAFLD fibrosis score below the lower cut-off level have a low risk of significant fibrosis and subsequent disease progression and can be safely managed in primary care. Referral to specialist care is indicated if disease progression is suspected on clinical or biochemical grounds. A score in the indeterminate range or above merits further investigation by use of modalities such as specialist scans or blood tests. Liver biopsy should be considered for those patients in whom non-invasive tests are inconclusive. The use of Fibroscan in this algorithm may later be replaced by serum marker panels. NFS, NAFLD fibrosis score; NAS, non-alcoholic steatosis.

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