Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

Zobair M. Younossi, Rohit Loomba, Quentin M. Anstee, Mary E. Rinella, Elisabetta Bugianesi, Giulio Marchesini, Brent A. Neuschwander-Tetri, Lawrence Serfaty, Francesco Negro, Stephen H. Caldwell, Vlad Ratziu, Kathleen E. Corey, Scott L. Friedman, Manal F. Abdelmalek, Stephen A. Harrison, Arun J. Sanyal, Joel E. Lavine, Philippe Mathurin, Michael R. Charlton, Zachary D. GoodmanNaga P. Chalasani, Kris V. Kowdley, Jacob George, Keith Lindor

Research output: Contribution to journalReview article

68 Citations (Scopus)

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a spectrum comprised of isolated steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and do not carry a significant risk for liver-related adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25%. In Asia, a gradient of high to low prevalence rates is noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition of NASH as an important liver disease, the diagnosis of NASH still requires a liver biopsy that is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, this method suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathological features. A number of noninvasive modalities to diagnose NASH and stage liver fibrosis are being developed. These modalities include predictive models (NAFLD fibrosis score) and serum biomarkers such as enhanced liver fibrosis (ELF). Other tests are based on radiological techniques, such as transient elastography (TE) or magnetic resonance elastography (MRE), which are used to estimate liver stiffness as a potential surrogate of hepatic fibrosis. Although a dynamic field of research, most of these diagnostic modalities have area under the curve ranging between 0.76 and 0.90%, with MRE having the best predictive performance. In summary, developing safe and easily accessible noninvasive modalities to accurately diagnose and monitor NASH and associated fibrosis is of utmost importance in clinical practice and clinical research. These tests are not only important to risk stratify subjects at the greatest risk for progressive liver disease, but also to serve as appropriate surrogate endpoints for therapeutic clinical trials of NASH. (Hepatology 2018;68:349-360).

Original languageEnglish (US)
Pages (from-to)349-360
Number of pages12
JournalHepatology
Volume68
Issue number1
DOIs
StatePublished - Jul 1 2018

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Fibrosis
Elasticity Imaging Techniques
Liver Cirrhosis
Liver
Non-alcoholic Fatty Liver Disease
Liver Diseases
Biomarkers
Biopsy
Observer Variation
Gastroenterology
Research
Area Under Curve
Economics
Clinical Trials

ASJC Scopus subject areas

  • Hepatology

Cite this

Younossi, Z. M., Loomba, R., Anstee, Q. M., Rinella, M. E., Bugianesi, E., Marchesini, G., ... Lindor, K. (2018). Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology, 68(1), 349-360. https://doi.org/10.1002/hep.29721

Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. / Younossi, Zobair M.; Loomba, Rohit; Anstee, Quentin M.; Rinella, Mary E.; Bugianesi, Elisabetta; Marchesini, Giulio; Neuschwander-Tetri, Brent A.; Serfaty, Lawrence; Negro, Francesco; Caldwell, Stephen H.; Ratziu, Vlad; Corey, Kathleen E.; Friedman, Scott L.; Abdelmalek, Manal F.; Harrison, Stephen A.; Sanyal, Arun J.; Lavine, Joel E.; Mathurin, Philippe; Charlton, Michael R.; Goodman, Zachary D.; Chalasani, Naga P.; Kowdley, Kris V.; George, Jacob; Lindor, Keith.

In: Hepatology, Vol. 68, No. 1, 01.07.2018, p. 349-360.

Research output: Contribution to journalReview article

Younossi, ZM, Loomba, R, Anstee, QM, Rinella, ME, Bugianesi, E, Marchesini, G, Neuschwander-Tetri, BA, Serfaty, L, Negro, F, Caldwell, SH, Ratziu, V, Corey, KE, Friedman, SL, Abdelmalek, MF, Harrison, SA, Sanyal, AJ, Lavine, JE, Mathurin, P, Charlton, MR, Goodman, ZD, Chalasani, NP, Kowdley, KV, George, J & Lindor, K 2018, 'Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis', Hepatology, vol. 68, no. 1, pp. 349-360. https://doi.org/10.1002/hep.29721
Younossi ZM, Loomba R, Anstee QM, Rinella ME, Bugianesi E, Marchesini G et al. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology. 2018 Jul 1;68(1):349-360. https://doi.org/10.1002/hep.29721
Younossi, Zobair M. ; Loomba, Rohit ; Anstee, Quentin M. ; Rinella, Mary E. ; Bugianesi, Elisabetta ; Marchesini, Giulio ; Neuschwander-Tetri, Brent A. ; Serfaty, Lawrence ; Negro, Francesco ; Caldwell, Stephen H. ; Ratziu, Vlad ; Corey, Kathleen E. ; Friedman, Scott L. ; Abdelmalek, Manal F. ; Harrison, Stephen A. ; Sanyal, Arun J. ; Lavine, Joel E. ; Mathurin, Philippe ; Charlton, Michael R. ; Goodman, Zachary D. ; Chalasani, Naga P. ; Kowdley, Kris V. ; George, Jacob ; Lindor, Keith. / Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. In: Hepatology. 2018 ; Vol. 68, No. 1. pp. 349-360.
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abstract = "Nonalcoholic fatty liver disease (NAFLD) is a spectrum comprised of isolated steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and do not carry a significant risk for liver-related adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25{\%}. In Asia, a gradient of high to low prevalence rates is noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition of NASH as an important liver disease, the diagnosis of NASH still requires a liver biopsy that is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, this method suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathological features. A number of noninvasive modalities to diagnose NASH and stage liver fibrosis are being developed. These modalities include predictive models (NAFLD fibrosis score) and serum biomarkers such as enhanced liver fibrosis (ELF). Other tests are based on radiological techniques, such as transient elastography (TE) or magnetic resonance elastography (MRE), which are used to estimate liver stiffness as a potential surrogate of hepatic fibrosis. Although a dynamic field of research, most of these diagnostic modalities have area under the curve ranging between 0.76 and 0.90{\%}, with MRE having the best predictive performance. In summary, developing safe and easily accessible noninvasive modalities to accurately diagnose and monitor NASH and associated fibrosis is of utmost importance in clinical practice and clinical research. These tests are not only important to risk stratify subjects at the greatest risk for progressive liver disease, but also to serve as appropriate surrogate endpoints for therapeutic clinical trials of NASH. (Hepatology 2018;68:349-360).",
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AU - Anstee, Quentin M.

AU - Rinella, Mary E.

AU - Bugianesi, Elisabetta

AU - Marchesini, Giulio

AU - Neuschwander-Tetri, Brent A.

AU - Serfaty, Lawrence

AU - Negro, Francesco

AU - Caldwell, Stephen H.

AU - Ratziu, Vlad

AU - Corey, Kathleen E.

AU - Friedman, Scott L.

AU - Abdelmalek, Manal F.

AU - Harrison, Stephen A.

AU - Sanyal, Arun J.

AU - Lavine, Joel E.

AU - Mathurin, Philippe

AU - Charlton, Michael R.

AU - Goodman, Zachary D.

AU - Chalasani, Naga P.

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AU - George, Jacob

AU - Lindor, Keith

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N2 - Nonalcoholic fatty liver disease (NAFLD) is a spectrum comprised of isolated steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and do not carry a significant risk for liver-related adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25%. In Asia, a gradient of high to low prevalence rates is noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition of NASH as an important liver disease, the diagnosis of NASH still requires a liver biopsy that is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, this method suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathological features. A number of noninvasive modalities to diagnose NASH and stage liver fibrosis are being developed. These modalities include predictive models (NAFLD fibrosis score) and serum biomarkers such as enhanced liver fibrosis (ELF). Other tests are based on radiological techniques, such as transient elastography (TE) or magnetic resonance elastography (MRE), which are used to estimate liver stiffness as a potential surrogate of hepatic fibrosis. Although a dynamic field of research, most of these diagnostic modalities have area under the curve ranging between 0.76 and 0.90%, with MRE having the best predictive performance. In summary, developing safe and easily accessible noninvasive modalities to accurately diagnose and monitor NASH and associated fibrosis is of utmost importance in clinical practice and clinical research. These tests are not only important to risk stratify subjects at the greatest risk for progressive liver disease, but also to serve as appropriate surrogate endpoints for therapeutic clinical trials of NASH. (Hepatology 2018;68:349-360).

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