Steatosis/steatohepatitis: how sustainable is the non-invasive instrumental differential diagnosis in clinical practice?

Abstract

Aim: Simple, rapid, and non-invasive methods for the early diagnosis of non-alcoholic steatohepatitis (NASH) in patients with fatty liver are an unmet need in clinical practice. Transient elastography (TE), commonly used for measuring liver stiffness (LS), which is significantly influenced by both liver fibrosis and inflammation is a promising tool. Methods: We studied retrospectively the impact of TE in a cohort of 98 consecutive asymptomatic patients with fatty liver who underwent a liver biopsy [21 non-alcoholic fatty liver (NAFL) and 77 NASH] and TE on the same day at the Hepatology Unit of University Hospital of Pisa. Patients positive for HBsAg, anti-HCV, HIV, autoantibodies, drug-induced liver disease, Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency, type 2 diabetes, or neoplasia were excluded. Results: NAFL patients were younger (42.5 years vs. 47.7 years, P = 0.02) and with lower BMI (25.5 kg/m 2 vs. 28.8 kg/m 2 , P < 0.001) than NASH patients. TE was higher in NASH than NAFL patients (8.1 kPa vs. 5.4 kPa, P = 0.01). Age, BMI, TE, and total/LDL cholesterol were statistically significantly different between NAFL and NASH patients, but with multivariate analysis only BMI (P = 0.009

Brain-gut-liver interactions across the spectrum of insulin resistance in metabolic fatty liver disease

“…Liver biopsy is the current gold standard in both the diagnosis and follow-up of liver disease. The presence of ballooning degeneration of hepatocytes being the hallmark of steatohepatitis, but biopsy is invasive and unsuitable for frequent monitoring[ 122 ]. Liver function tests are useful, but not diagnostic or predictive of NASH and/or fibrosis in individual patient.…”