Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2025; 31(37): 107665
Published online Oct 7, 2025. doi: 10.3748/wjg.v31.i37.107665
Published online Oct 7, 2025. doi: 10.3748/wjg.v31.i37.107665
Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations
Jesse Pustjens, Willem P Brouwer, Ibrahim Ayada, Harry L A Janssen, Laurens A van Kleef, Department of Gas
Harry L A Janssen, Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada
Author contributions: Van Kleef LA, Pustjens J, and Brouwer WP contributed to writing of the manuscript; van Kleef LA, Pustjens J, Ayada I, Janssen HLA, and Brouwer WP contributed to critical review of the manuscript, writing of the manuscript, approval of final version and approval of submission.
Conflict-of-interest statement: Brouwer WP received a speaker fee from Eli Lilly, partakes in the advisory board for Novo Nordisk and is involved in trials from 89BIO, Boehringer Ingelheim, Novo Nordisk and Inventiva Pharma; Janssen HLA received grants from Gilead Sciences, GlaxoSmithKline, Janssen, Roche and Vir Biotechnology Inc and is consultant for Aligos, Gilead Sciences, GlaxoSmithKline, Grifols, Roche, Vir Biotechnology Inc. and Precision Biosciences. The other authors had no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Laurens A van Kleef, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Room Na-606, Postbus 2040, Rotterdam 3000, Zuid-Holland, Netherlands. l.vankleef@erasmusmc.nl
Received: March 30, 2025
Revised: June 18, 2025
Accepted: August 22, 2025
Published online: October 7, 2025
Processing time: 181 Days and 22 Hours
Revised: June 18, 2025
Accepted: August 22, 2025
Published online: October 7, 2025
Processing time: 181 Days and 22 Hours
Core Tip
Core Tip: Early detection of liver fibrosis in community settings is essential for timely intervention and to prevent liver related events. Although non-invasive testing strategies are likely cost-effective, their adoption by non-hepatology specialists is limited. Key challenges include the use of overly broad target populations and suboptimal selection or application of non-invasive tests (NITs). Optimizing these pathways by integrating better NITs and refining referral algorithms can improve risk stratification, minimize unnecessary specialist referrals, reduce the burden on healthcare systems, and facilitate timely, multidisciplinary care for individuals at the highest risk for liver-related adverse outcomes.