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.

Reference: Mueller S, Millonig G, Sarovska L, Friedrich S, Reimann FM, Pritsch M, Eisele S, Stickel F, Longerich T, Schirmacher P, Seitz HK. Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis. World J Gastroenterol 2010; 16(8): 966-972

http://www.wjgnet.com/1007-9327/16/966.asp

Correspondence to: Sebastian Mueller, MD, PhD, Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11-33, 69121 Heidelberg, Germany. sebastian.mueller@urz.uni-heidelberg.de

Telephone: +49-6221-483210 Fax: +49-6221-484494

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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