2018, Number 6
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Ann Hepatol 2018; 17 (6)
The evolving role of liver biopsy in non-alcoholic fatty liver disease
Arab JP, Barrera F, Arrese M
Language: English
References: 14
Page: 899-902
PDF size: 114.83 Kb.
ABSTRACT
Evaluation patients with nonalcoholic steatohepatitis (NASH) imply the need of appropriate assessment of disease severity (i.e. the
presence of NASH) as well as of the disease stage (i.e. the extent of liver fibrosis). Liver biopsy (LB) is still considered the gold
standard for diagnosing NASH as well as for establishing the degree of liver fibrosis. However, due to its invasive nature and costs,
use of LB should be restricted to selected patients and, according guidelines and expert opinion, indicated in the following scenarios:
a) when LB will guide treatment, b) to confirm or exclude NAFLD in patients with conflicting clinical data, c) to increase patient’s
awareness about their disease, and improve engagement in their care and d) for inclusion in clinical trials. However, the role fo LB in
NAFLD is evolving since when new and costly therapeutic agents become available, LB will be eventually necessary to make clinical
decisions. The use of non-invasive tools (NITs) to assess steatosis, NASH and hepatic fibrosis is useful to triage NAFLD patients
and decide in whom perform a LB.
REFERENCES
Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67: 328-57.
European Association for the Study of the L, European Association for the Study of D, European Association for the Study of O. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64: 1388-402.
Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, George J, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018; 15: 11-20.
Bedossa P. Diagnosis of non-alcoholic fatty liver disease/ non-alcoholic steatohepatitis: Why liver biopsy is essential. Liver Int 2018; 38(Suppl. 1): 64-6.
Castera L. Diagnosis of non-alcoholic fatty liver disease/ non-alcoholic steatohepatitis: Non-invasive tests are enough. Liver Int 2018; 38(Suppl. 1): 67-70.
Brunt EM. Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation. Hepatol Commun 2017; 1: 370-8.
Ratziu V. Back to Byzance: Querelles byzantines over NASH and fibrosis. J Hepatol 2017; 67: 1134-6.
Arab JP, Arrese M, Trauner M. Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease. Annu Rev Pathol 2018; 13: 321-50.
Schuster S, Cabrera D, Arrese M, Feldstein AE. Triggering and resolution of inflammation in NASH. Nat Rev Gastroenterol Hepatol 2018; 15: 349-64.
Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, Sebastiani G, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology 2017; 65: 1557-65.
Gunn NT, Shiffman ML. The Use of Liver Biopsy in Nonalcoholic Fatty Liver Disease: When to Biopsy and in Whom. Clin Liver Dis 2018; 22: 109-19.
Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver D. Liver biopsy. Hepatology 2009; 49: 1017-44.
Pelusi S, Valenti L. Hepatic fat as clinical outcome and therapeutic target for nonalcoholic fatty liver disease. Liver Int 2018; in press.
Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. J Hepatol 2018; 68: 305-15.