Noninvasive assessment of fibrosis in patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is prevalent in 20-25% of the general population and is associated with metabolic risk factors such as obesity, diabetes mellitus, and dyslipidemia. Histologically, NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), fbrosis, and cirrhosis. As NASH develops in only 10-15% of patients with NAFLD, it is not practical to biopsy all patients who present with NAFLD. Noninvasive fbrosis tests have been extensively developed recently and ofer alternatives for staging fbrosis. Despite their increasing use, such tests cannot adequately differentiate simple steatosis from NASH. At present, such tests can be used as first line tests to rule out patients without advanced fbrosis and thus prevent unnecessary secondary care refferrals in a significant number of patients. In this review we present the evidence for the use of noninvasive fbrosis tests in patients with NAFLD.