Noninvasive diagnosis in alcohol‐related liver disease

Abstract

Background Alcohol‐related liver disease (ALD) represents a major cause of death worldwide, and unfortunately, most patients are diagnosed at an advanced stage of the disease, which is related to poorer outcomes. Liver biopsy has historically been the gold standard for identifying advanced hepatic fibrosis, but this approach has several limitations, including invasiveness, low applicability, sampling variability, and cost. Main Text In order to detect earlier features of advanced liver fibrosis, surrogate biomarkers and techniques have been developed. While these were initially developed for chronic liver diseases such as viral hepatitis and nonalcoholic fatty liver disease (NAFLD), their performance in ALD has also been recently studied. Among the noninvasive surrogate markers and techniques used to detect liver fibrosis, the Enhanced Liver Fibrosis test, FibroTest, and Transient Elastography are the most accurate and validated techniques. In this review, we summarize the current status of the noninvasive assessment of liver disease in ALD and provide a synthesis of how these noninvasive tools can be used in clinical practice. Finally, we briefly outline novel biomarkers that are currently being investigated and discuss future directions and new opportunities in the noninvasive diagnosis of ALD.

Oxidative Stress and Pro-Inflammatory Status in Patients with Non-Alcoholic Fatty Liver Disease

“…Nowadays, the most reliable method of diagnosing NAFLD is through a liver biopsy, but since it is a long-term disease and an invasive method, it is complex to follow large groups of people through serial biopsies [ 13 ]. Other methods for diagnosis include a complete ultrasound, which is usually the first test when liver disease is suspected, magnetic resonance imaging (MRI), which allows for a good diagnosis, and elastography, which is an improved form of ultrasound to measure liver stiffness, indicative of fibrosis or scarring [ 14 ]. Therefore, many people suffering from NAFLD are not diagnosed until the disease has progressed to a more serious stage.…”

The Place of Liver Elastography in Diagnosis of Alcohol-Related Liver Disease

“…Nonpatented serum markers have been assessed in ALD for the diagnosis of liver fibrosis-age-platelet index, the aspartate transaminase (AST)-platelet-ratio index APRI [12], fibrosis-4 index-FIB-4 [13], and AST/alanine aminotransferase (ALT) ratio-AST/ALT [14]. A comparison of the performance of the different biological scores suggests that ELF and FT are better in the diagnosis of LF in ALD (Table 1) [9,16].…”

“…All patients with AUD need to be referred to a specialized withdrawal center. Follow-up can be performed by primary care or in case of advanced liver fibrosis by liver clinic units for specific investigations [7,16].…”

Could Protein Content of Urinary Extracellular Vesicles be Useful to Detect Alcoholic Liver Disease and Assess Hepatocarcinoma Risk?

“…Firstly, screening question-based tests assess alcohol abuse and dependence [13] and biochemical parameters that include direct alcohol detection and cellular damage by alcohol intake give rise to an initial diagnostic assessment [13,14]. Additionally, different predictive scores combining many biochemical parameters help obtain a more precise evaluation [14][15][16][17]. Nevertheless, none of these parameters are fully efficient in diagnosis and prognosis and all of them lack of specificity and capability of truthfully discriminate ALD from other causes of liver disease, such as obesity, viral hepatitis, and exposure to other toxics [6].…”