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World J Gastroenterol. Oct 21, 2015; 21(39): 11044-11052
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11044
Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London NW3 2QG, United Kingdom
Author contributions: Lombardi R had the primary authorship of the manuscript; Buzzetti E and Roccarina D performed the literature research and prepared the tables; Tsochatzis EA revised the manuscript for important intellectual content; all authors approved the manuscript before the final submission.
Conflict-of-interest statement: Nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emmanuel A Tsochatzis, PhD, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, Pond Street, London NW3 2QG, United Kingdom. e.tsochatzis@ucl.ac.uk
Telephone: +44-207-7940500 Fax: +44-207-4726226
Received: April 21, 2015
Peer-review started: April 23, 2015
First decision: June 2, 2015
Revised: July 30, 2015
Accepted: August 30, 2015
Article in press: August 30, 2015
Published online: October 21, 2015
Processing time: 180 Days and 10.1 Hours
Abstract

Alcoholic liver disease (ALD) consists of a broad spectrum of disorders, ranging from simple steatosis to alcoholic steatohepatitis and cirrhosis. Fatty liver develops in more than 90% of heavy drinkers, however only 30%-35% of them develop more advanced forms of ALD. Therefore, even if the current “gold standard” for the assessment of the stage of alcohol-related liver injury is histology, liver biopsy is not reasonable in all patients who present with ALD. Currently, although several non-invasive fibrosis markers have been suggested as alternatives to liver biopsy in patients with ALD, none has been sufficiently validated. As described in other liver disease, the diagnostic accuracy of such tests in ALD is acceptable for the diagnosis of significant fibrosis or cirrhosis but not for lesser fibrosis stages. Existing data suggest that the use of non-invasive tests could be tailored to first tier screening of patients at risk, in order to diagnose early patients with progressive liver disease and offer targeted interventions for the prevention of decompensation. We review these tests and critically appraise the existing evidence.

Keywords: Transient elastography; Cirrhosis; Prognosis; Histology; Collagen proportionate area; Fibrotest; AST-to-platelet ratio index; Diagnostic accuracy; Cost-effectiveness; Serum fibrosis markers

Core tip: Although there has been an explosive development and validation of non-invasive fibrosis tests particularly in viral hepatitis, data on patients with alcoholic liver disease are still scarce. We review these tests and critically appraise the existing literature. Evidence suggests that such tests could be tailored to first tier screening of patients at risk, in order to diagnose early patients with progressive liver disease and offer targeted interventions for the prevention of decompensation.