scholarly journals Motion – All Patients with NASH Need to Have a Liver Biopsy: Arguments against the Motion

2002 ◽  
Vol 16 (10) ◽  
pp. 722-726 ◽  
Author(s):  
Jacqueline Laurin
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Nonalcoholic Fatty Liver ◽  
Histological Assessment ◽  
Clinical Benefits ◽  
Liver Biopsies ◽  
Alpha 1 Antitrypsin ◽  
Iron Profile

Most cases of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are suspected on the basis of the exclusion of viral, autoimmune, metabolic and genetic causes of chronic liver disease in patients with chronic elevation of aminotransferase enzymes. However, the definitive diagnosis of NASH requires liver biopsy. Valuable blood tests include hepatitis B and C serology, iron profile, alpha 1-antitrypsin phenotype, ceruloplasmin, antinuclear antibody and antismooth muscle antibody, and serum protein electrophoresis. If these tests are negative or normal, and if there are no symptoms or signs of chronic liver disease, it is unlikely that a specifically treatable liver disease would be discovered at biopsy. The prevalence of NAFLD in the general population appears to be approximately 20%, and 2% to 3% of people have NASH. There is no proven specific therapy for the spectrum of nonalcoholic liver disease; therefore, the management of the patient with NASH is not likely to be changed after histological assessment. Bleeding, sometimes fatal, and other complications requiring hospitalization can occur, and liver biopsies should not be undertaken without clear clinical indications. The high cost of undertaking histological assessment of all persons with asymptomatic elevations of liver enzymes cannot be justified in view of the risks and limited clinical benefits.

scholarly journals The role of elastography in the assessment of chronic liver disease in children

2019 ◽  
Vol 19 (3) ◽  
pp. 2806-2311
Author(s):  
Süleyman Sönmez ◽  
Merve Boşat ◽  
Nihal Yurtseven ◽  
Eray Yurtseven
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Chronic Liver Disease ◽  
Real Time ◽  
Correlation Coefficient ◽  
Hepatic Fibrosis ◽  
Pearson Correlation ◽  
Chronic Liver ◽  
Liver Biopsies

Background: Conventional ultrasonography is a method preferred for the investigation of chronic liver diseases in pediatric groups, as it is non-invasive, cheap, feasible and available. The purpose of this study is to present the role of Share-wave Elastography (SWE) in terms of diagnostic value in children diagnosed with “chronic liver disease.”Methods: We studied patients who had been diagnosed with chronic liver disease between March 2012-September 2015, and who had undergone liver biopsy and had their pathology results, compared with 26 healthy subjects. Statistical analysis was performed with IBM SPSS Statistics for Windows, Version 20.0. “Pearson Correlation Analysis” was performed in order to measure the relationship between elastography values and Brunt level.Results: This study had 107 subjects in total, consisting of 81 patients between 0-204 months of age Pearson correlation coefficient level was determined as r = 0.644. Since the correlation coefficient is positive, there is a same-directional relationship between Elastography level and Brunt degree. This means that while one of the variables is increasing, the other one will also increase.Conclusion: Since it is known that development of hepatic fibrosis is a dynamic process, and that many hepatic fibrosis etiologies are known to continue throughout the course of life, the application of Real time SWE method instead of repeated liver biopsies on patients is a much simpler and smart method. Increasing the clinical use of Real Time SWE method with future studies might provide an opportunity for preventing unnecessary liver biopsies since the patients are evaluated in a shorter time and in a cost-effective manner.Keywords: Shear-Wave Elastography, Brunt degree, chronic liver disease, liver biopsy.

scholarly journals Nonalcoholic Fatty Liver Disease: A New Frontier for Hepatology in Bangladesh and a Call for Action to Combat

2017 ◽  
Vol 35 (4) ◽  
pp. 184-191
Author(s):  
Shahinul Alam ◽  
M Motahar Hossain ◽  
Golam Azam ◽  
Golam Mustafa ◽  
Mahbubul Alam ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Chronic Liver Disease ◽  
Fatty Liver Disease ◽  
Chronic Liver ◽  
Diabetic Patients ◽  
Socioeconomic Condition ◽  
Mortality And Morbidity ◽  
Nonalcoholic Fatty Liver

Nonalcoholic Fatty Liver Disease (NAFLD) is the condition where fat accumulates in liver without significant ingestion of alcohol. NAFLD has become one of the most common liver conditions throughout the world. At the dawn of the history of NAFLD it was thought that NAFLD is disease of obese individual but lean patients are increasingly detected to have NAFLD. It seems that insulin resistance is central to the pathogenesis of NAFLD. In addition, oxidative stress and cytokines are important contributing factors, resulting in steatosis and progressive liver damage in genetically susceptible individuals. NAFLD varies considerably by ethnic group and Bangladeshi ethnicity is an independent risk factor for NAFLD. Prevalence of NAFLD in general population of Bangladesh is 4 - 18.4 %, which jumps up to 49.8% in diabetic patients. With the changes in socioeconomic condition and life style, aetiology of chronic liver disease is drifting from infectious to noninfectious diseases and the contribution of NAFLD is progressively increasing. Hepatitis B and hepatitis C have been the leading causes of mortality and morbidity from chronic liver disease in Bangladesh. But with increase in awareness and mass vaccination against HBV, prevalence of both the diseases has been decreasing in the country. The most alarming feature is that there is a high prevalence of NASH among the NAFLD patients. NAFLD is emerging as the largest contributor of chronic liver disease in Bangladesh. This warrants the attention of health policy makers and clinicians to explore this frontier and combat it from right now.J Bangladesh Coll Phys Surg 2017; 35(4): 184-191

scholarly journals Ultrasound-based liver elastography: current results and future perspectives

2020 ◽  
Vol 45 (11) ◽  
pp. 3463-3472
Author(s):  
Cheng Fang ◽  
Paul S. Sidhu
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Chronic Liver Disease ◽  
Research Direction ◽  
Chronic Liver ◽  
Current Evidence ◽  
Diffuse Liver Disease ◽  
Disease Spectrum ◽  
Liver Elastography

Abstract Chronic liver disease affects 185 million population worldwide. It encompasses a heterogenous disease spectrum, but all can lead to the development of liver fibrosis. The degree of liver fibrosis is not only a prognosticator, but has also been used to guide the treatment strategy and to evaluate treatment response. Traditionally, staging of liver fibrosis is determined on histological analysis using samples obtained from an invasive liver biopsy. Ultrasound-based liver elastography is a non-invasive method of assessing diffuse liver disease in patients with known chronic liver disease. The use of liver elastography has led to a significant reduction in the number of liver biopsies performed to assess the severity of liver fibrosis and a liver biopsy is now reserved for only select sub-groups of patients. The aim of this review article is to discuss the key findings and current evidence for ultrasound-based elastography in diffuse liver disease as well as the technical challenges and to evaluate the potential research direction.

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