Liver fibrosis in patients with non-alcoholic fatty liver disease: diagnostic options in clinical practice.

Introduction: With the obesity burden, non-alcoholic fatty liver disease (NAFLD) is present in 20 - 30% of the general population. Few NAFLD patients will develop end-stage liver disease, for which the main predictor is the liver fibrosis stage. It is thus mandatory to evaluate liver fibrosis in NAFLD patients to determine their liver-related prognosis.

Areas covered: Here the authors discuss the various options available for liver fibrosis diagnosis in clinical practice in NAFLD patients. At present, liver biopsy remains the reference examination. In the past decade, several non-invasive fibrosis tests, for example, elastography techniques or blood tests, have been developed and evaluated for the diagnosis of liver fibrosis in NAFLD. Their accuracy, advantages and limitations will be discussed.

Expert opinion: Liver biopsy, an invasive procedure, is not appropriate for routine fibrosis evaluation and follow-up in the large population of NAFLD patients. Non-invasive fibrosis tests are accurate tools to evaluate liver fibrosis and thus identify at-risk patients for liver-related complications. They represent an exciting research field as further studies are required to definitively validate their diagnostic and prognostic utility.