• Open Access

Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

Authors

  • J. K. Dowman,

    1. Centre for Liver Research, 5th floor, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
    2. The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
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  • J. W. Tomlinson,

    1. Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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  • P. N. Newsome

    1. Centre for Liver Research, 5th floor, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
    2. The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
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Dr J. K. Dowman, Centre for Liver Research, 5th floor, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
E-mail: j.k.dowman@bham.ac.uk

Abstract

Aliment Pharmacol Ther 2011; 33: 525–540

Summary

Background  Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease in Western countries. The development of non-alcoholic steatohepatitis (NASH) and fibrosis identifies an at-risk group with increased risk of cardiovascular and liver-related deaths. The identification and management of this at-risk group remains a clinical challenge.

Aim  To perform a systematic review of the established and emerging strategies for the diagnosis and staging of NAFLD.

Methods  Relevant research and review articles were identified by searching PubMed, MEDLINE and EMBASE.

Results  There has been a substantial development of non-invasive risk scores, biomarker panels and radiological modalities to identify at-risk patients with NAFLD without recourse to liver biopsy on a routine basis. These modalities and algorithms have improved significantly in their diagnosis and staging of fibrosis and NASH in patients with NAFLD, and will likely impact on the number of patients undergoing liver biopsy.

Conclusions  Staging for NAFLD can now be performed by a combination of radiological and laboratory techniques, greatly reducing the requirement for invasive liver biopsy.

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