Novel criteria to differentiate fibrosis from steatohepatitis
Alcoholic liver disease (ALD) is the most common cause of liver cirrhosis in the Western world. Liver biopsy is currently considered the gold standard for assessing hepatic fibrosis or cirrhosis in these patients.
However, it is an invasive procedure, with rare but potentially life-threatening complications and its accuracy is limited due to sampling error. Transient elastography (FibroScan®, FS) is a novel rapid and noninvasive method to assess liver fibrosis via measurement of liver stiffness (LS). Although LS closely correlates with fibrosis stage, it also increases in patients with inflammation (steatohepatitis) which often confounds fibrosis in patients with ALD. Thus, novel criteria are urgently required to determine whether LS is increased due to fibrosis or inflammation.
A research article published on February 28, 2010 in the World Journal of Gastroenterology addresses this question. The research team lead by Dr. Sebastian Mueller from Heidelberg University identified in their recent study novel bedside criteria that allowed the differentiation of cirrhosis from inflammation in patients with ALD.
Their results showed that active inflammation of the liver (steatohepatitis) should be excluded first by blood tests prior to the noninvasive assessment of liver fibrosis by transient elastography. If glutamic oxaloacetic transaminase levels are < 100 u/l, the ls value can identify liver fibrosis and can be used as a diagnostic tool.
These novel criteria probably also hold true for other liver disease.