Editorial
Copyright ©2010 Baishideng. All rights reserved.
World J Hepatol. Jul 27, 2010; 2(7): 251-255
Published online Jul 27, 2010. doi: 10.4254/wjh.v2.i7.251
Non-invasive methods for liver fibrosis prediction in hemochromatosis: One step beyond
Agustin Castiella, Eva Zapata, José M Alústiza
Agustin Castiella, Eva Zapata, Gastroenterology Service, Mendaro Hospital, Mendaro 20850, Spain
José M Alústiza, Radiology Service, Osatek Donostia, San Sebastián 20014, Spain
Author contributions: Castiella A, Zapata E, and Alústiza JM contributed equally to the article in accordance with the standard proposed by the International Committee of Medical Journal Editors.
Correspondence to: Agustin Castiella, MD, Gastroenterology Service, Mendaro Hospital, Barrio Mendarozabal, Mendaro 20850, Spain. agustincastiella@yahoo.es
Telephone: +34-94-3032800 Fax: +34-94-3032836
Received: April 10, 2010
Revised: July 7, 2010
Accepted: July 14, 2010
Published online: July 27, 2010
Abstract

Advances in recent years in the understanding of, and the genetic diagnosis of hereditary hemochromatosis (HH) have changed the approach to iron overload hereditary diseases. The ability to use a radiologic tool (MRI) that accurately provides liver iron concentration determination, and the presence of non-invasive serologic markers for fibrosis prediction (serum ferritin, platelet count, transaminases, etc), have diminished the need for liver biopsy for diagnosis and prognosis of this disease. Consequently, the role of liver biopsy in iron metabolism disorders is changing. Furthermore, the irruption of transient elastography to assess liver stiffness, and, more recently, the ability to determine liver fibrosis by means of MRI elastography will change this role even more, with a potential drastic decline in hepatic biopsies in years to come. This review will provide a brief summary of the different non-invasive methods available nowadays for diagnosis and prognosis in HH, and point out potential new techniques that could come about in the next years for fibrosis prediction, thus avoiding the need for liver biopsy in a greater number of patients. It is possible that liver biopsy will remain useful for the diagnosis of associated diseases, where other non-invasive means are not possible, or for those rare cases displaying discrepancies between radiological and biochemical markers.

Keywords: Hemochromatosis; Iron overload; Liver fibrosis; Non-invasive; Magnetic resonance imaging; Ultrasound elastography