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World J Gastroenterol. Oct 28, 2014; 20(40): 14626-14641
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14626
Non-invasive diagnosis of alcoholic liver disease
Sebastian Mueller, Helmut Karl Seitz, Vanessa Rausch
Sebastian Mueller, Helmut Karl Seitz, Department of Internal Medicine, Salem Medical Center, University of Heidelberg, 69121 Heidelberg, Germany
Sebastian Mueller, Helmut Karl Seitz, Vanessa Rausch, Center for Alcohol Research, University of Heidelberg, 69121 Heidelberg, Germany
Author contributions: Mueller S and Rausch V analyzed the data and wrote the paper; Seitz HK critically revised the paper and added comments.
Correspondence to: Sebastian Mueller, MD, PhD, Professor, Vice Head, Research Director, Department of Internal Medicine, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11-33, 69121 Heidelberg, Germany.
Telephone: +49-6221-483210 Fax: +49-6221-483494
Received: February 10, 2014
Revised: April 30, 2014
Accepted: July 22, 2014
Published online: October 28, 2014

Alcoholic liver disease (ALD) is the most common liver disease in the Western world. For many reasons, it is underestimated and underdiagnosed. An early diagnosis is absolutely essential since it (1) helps to identify patients at genetic risk for ALD; (2) can trigger efficient abstinence namely in non-addicted patients; and (3) initiate screening programs to prevent life-threatening complications such as bleeding from varices, spontaneous bacterial peritonitis or hepatocellular cancer. The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis (AH). The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on a combination of laboratory, clinical and imaging findings. It is not widely conceived that conventional screening tools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca. 40% of manifest alcoholic liver cirrhosis. Non-invasive methods such as transient elastography (Fibroscan), acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholic cirrhosis. Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca. 95% of patients. The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels. Other non-invasive methods such as controlled attenuation parameter, serum levels of M30 or M65, susceptometry or breath tests are under current evaluation to assess the degree of steatosis, apoptosis and iron overload in these patients. Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.

Keywords: Alcoholic hepatitis, Alcoholic steatohepatitis, Alcoholic liver disease, Non-invasive, Liver stiffness, Serum marker, Steatosis

Core tip: This review article summarizes recent advantages in non-invasive assessment of patients with alcoholic liver disease (ALD) such as elastographic techniques (Fibroscan), acoustic radiation force impulse imaging, shear wave elastography or serum marker and highlights future perspectives which may improve the early diagnosis of ALD.