The following is a summary of “Non-invasive diagnosis and monitoring of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis,” published in the July 2023 issue of  Gastroenterology & Hepatology by Tincopa et al.

Non-alcoholic hepatic steatosis (NAHS) is a widely prevalent type of chronic hepatopathy that presents difficulties in diagnosis and risk assessment. Non-alcoholic steatohepatitis (NASH), the advanced manifestation of non-alcoholic fatty liver disease (NAFLD), poses a significant diagnostic challenge when histological evidence is unavailable. The hepatic biopsy is seldom conducted owing to its invasive characteristics, the potential for sampling inaccuracies, and the absence of inter-rater consistency. Non-invasive medical examinations that can precisely identify patients with high-risk non-alcoholic steatohepatitis (NASH) (i.e., individuals with biopsy-confirmed NASH with a NAFLD activity score [NAS] of 4 or higher and fibrosis stage of 2 or higher) are crucial tools for identifying suitable candidates for pharmaceutical treatment in clinical trials aimed at treating fibrosis associated with NASH. 

With the advent of pharmacotherapy advancements, it has become imperative to employ non-invasive diagnostic tests to monitor treatment efficacy. Lastly, there is a lack of non-invasive diagnostic tests to evaluate the risk of clinical outcomes such as the progression to cirrhosis, hepatic decompensation, liver-related mortality, and overall mortality. In this medical review, researchers analyze the progress made in non-invasive diagnostic and monitoring techniques for identifying and tracking non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. The liver biopsy is widely regarded as the gold standard diagnostic method for identifying non-alcoholic steatohepatitis and staging hepatic fibrosis. Liver biopsy, an invasive medical procedure, presents several inherent risks and significant costs. These risks include post-procedural pain experienced by approximately 50% of patients and rare but potentially life-threatening complications such as bleeding, which occurs in about 0.6-1% of cases.

From a medical standpoint, the execution of a liver biopsy necessitates access to a facility equipped with peri-procedural and post-procedural monitoring capabilities and a skilled operator possessing specialized medical expertise. It is important to note that these requirements can incur significant costs. In addition to the procedure’s potential risks and associated expenses, liver biopsy has several limitations that reduce its accuracy and reproducibility. These factors encompass the possibility of sampling error and intra-rater and inter-rater variability. The utilization of hepatic biopsy is thus constrained in practical clinical settings, necessitating the development of non-invasive diagnostic methods to effectively tackle the challenges associated with diagnosing and stratifying the risk of non-alcoholic fatty liver disease and steatohepatitis.

Source: sciencedirect.com/science/article/abs/pii/S2468125323000663