Our Summary

This research paper is a review of the progress made over the last 20 years in diagnosing and assessing the risk of chronic liver diseases (CLDs) without having to use invasive methods, such as liver biopsies. The paper talks about two main ways to do this: one is by testing blood samples for certain indicators (biomarkers), and the other is by measuring the stiffness of the liver using ultrasound or magnetic resonance. The most commonly used methods are the fibrosis-4 index (a blood test) and a technique called vibration-controlled transient elastography (a type of ultrasound). The paper discusses how accurately these non-invasive tests can diagnose CLDs, and how they have changed the field of liver disease treatment. This includes identifying cirrhosis (scarring of the liver) early in patients at risk of CLDs, diagnosing portal hypertension (high blood pressure in the liver), predicting the outcome in cases of compensated cirrhosis (where the liver is damaged but still works), guiding antiviral treatment, and screening for fibrosis (scarring) and cirrhosis in regular healthcare settings.

FAQs

  1. What are the most widely adopted non-invasive tests for diagnosing and assessing the risk of chronic liver diseases?
  2. How have non-invasive tests changed the practice of hepatology in the current era?
  3. What are some of the uses for non-invasive tests in the diagnosis and management of chronic liver diseases?

Doctor’s Tip

A doctor might advise a patient undergoing a liver biopsy to avoid taking any blood-thinning medications, such as aspirin or ibuprofen, in the days leading up to the procedure. This can help reduce the risk of excessive bleeding during and after the biopsy. It is also important to inform the doctor of any allergies or medical conditions that may affect the procedure. Finally, following the biopsy, the patient should rest and avoid strenuous activities for a period of time to allow the liver to heal properly.

Suitable For

Patients who are typically recommended for liver biopsy include:

  1. Patients with suspected liver disease of unknown etiology, where non-invasive tests have not provided a definitive diagnosis
  2. Patients with chronic liver diseases such as hepatitis B or C, non-alcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or primary biliary cirrhosis
  3. Patients with elevated liver enzymes and/or abnormal liver function tests
  4. Patients with suspected liver fibrosis or cirrhosis, to assess the severity and stage of the disease
  5. Patients with suspected liver tumors or lesions, to determine if they are malignant or benign
  6. Patients undergoing treatment for liver disease, to monitor response to therapy and disease progression
  7. Patients with a history of liver disease or risk factors for liver disease, such as alcohol abuse, obesity, diabetes, or viral hepatitis
  8. Patients being evaluated for liver transplant or other surgical interventions for liver disease.

Timeline

Before liver biopsy:

  • Patient presents with symptoms or risk factors for chronic liver disease (CLD)
  • Patient undergoes blood tests to assess liver function and potential biomarkers for liver fibrosis
  • Patient may undergo imaging tests, such as ultrasound or MRI, to assess liver stiffness
  • If non-invasive tests suggest liver fibrosis, patient may be recommended for a liver biopsy to confirm diagnosis and stage of fibrosis

After liver biopsy:

  • Liver biopsy is performed to obtain a tissue sample for analysis
  • Patient may experience mild discomfort or pain at the biopsy site
  • Biopsy sample is sent for analysis to determine the degree of fibrosis, inflammation, and other liver conditions
  • Results of the liver biopsy help guide treatment decisions and prognosis for the patient
  • Patient may require follow-up appointments to monitor liver health and response to treatment based on biopsy results

What to Ask Your Doctor

  1. What are the reasons for recommending a liver biopsy in my case?
  2. What information will the liver biopsy provide that other non-invasive tests cannot?
  3. What are the potential risks and complications associated with a liver biopsy?
  4. How should I prepare for the liver biopsy procedure?
  5. Will I need to fast before the procedure?
  6. How long will the liver biopsy procedure take?
  7. Will I be sedated during the procedure?
  8. How long will it take to receive the results of the liver biopsy?
  9. What are the possible outcomes of the liver biopsy results?
  10. How will the results of the liver biopsy impact my treatment plan moving forward?

Reference

Authors: Anstee QM, Castera L, Loomba R. Journal: J Hepatol. 2022 Jun;76(6):1362-1378. doi: 10.1016/j.jhep.2022.03.026. PMID: 35589256