Topic Highlight
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2015; 21(39): 11077-11087
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11077
Liver fibrosis in non-alcoholic fatty liver disease - diagnostic challenge with prognostic significance
Per Stål
Per Stål, Division of Gastroenterology and Hepatology, Karolinska Institutet, Department of Digestive Diseases, Huddinge K63, Karolinska University Hospital, S-141 86 Stockholm, Sweden
Author contributions: Stål P analyzed the literature and wrote the manuscript.
Supported by Ruth and Richard Julins Foundation, the Stockholm County Council (ALF projects No. 20140329 and No. 20150403); and the Swedish Society of Medicine (Gastroenterology Research Fund).
Conflict-of-interest statement: The author has received fees for serving as a speaker from Bayer AB, Sweden. The author has no other conflicts of interest to report.
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: Per Stål, MD, PhD, Division of Gastroenterology and Hepatology, Karolinska Institutet, Department of Digestive Diseases, Huddinge K63, Karolinska University Hospital, S-141 86 Stockholm, Sweden. per.stal@karolinska.se
Telephone: +46-704-255288 Fax: +46-8-58582335
Received: May 4, 2015
Peer-review started: May 9, 2015
First decision: June 23, 2015
Revised: July 18, 2015
Accepted: September 13, 2015
Article in press: September 13, 2015
Published online: October 21, 2015
Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world, with a prevalence of 20%. In a subgroup of patients, inflammation, ballooning degeneration of hepatocytes and a varying degree of fibrosis may develop, a condition named non-alcoholic steatohepatitis. Advanced liver fibrosis (stage F3) and cirrhosis (stage F4) are histologic features that most accurately predict increased mortality in both liver-related and cardiovascular diseases. Patients with advanced fibrosis or cirrhosis are at risk for complications such as hepatocellular carcinoma and esophageal varices and should therefore be included in surveillance programs. However, liver disease and fibrosis are often unrecognized in patients with NAFLD, possibly leading to a delayed diagnosis of complications. The early diagnosis of advanced fibrosis in NAFLD is therefore crucial, and it can be accomplished using serum biomarkers (e.g., the NAFLD Fibrosis Score, Fib-4 Index or BARD) or non-invasive imaging techniques (transient elastography or acoustic radiation force impulse imaging). The screening of risk groups, such as patients with obesity and/or type 2 diabetes mellitus, for NAFLD development with these non-invasive methods may detect advanced fibrosis at an early stage. Additionally, patients with a low risk for advanced fibrosis can be identified, and the need for liver biopsies can be minimized. This review focuses on the diagnostic challenge and prognostic impact of advanced liver fibrosis in NAFLD.

Keywords: Non-alcoholic fatty liver disease, Fibrosis, Mortality, Biomarkers, Elastography

Core tip: Non-alcoholic fatty liver disease (NAFLD) has a prevalence of 20% in the Western world. A subgroup of NAFLD patients develops inflammation and fibrosis or cirrhosis. This condition, named non-alcoholic steatohepatitis, is associated with increased mortality in liver-related and cardiovascular diseases. Advanced liver fibrosis is the histologic feature that most accurately predicts future morbidity; therefore, early detection of advanced fibrosis is crucial. Serum biomarkers, such as the NAFLD Fibrosis Score, Fib-4 Index or BARD, or non-invasive imaging techniques, such as transient elastography, may identify patients with a low risk for advanced fibrosis and minimize the need for liver biopsy.