January 28, 2014
According to researchers, the main causes of persistent liver disease include:
Regardless of the instigator of chronic liver disease, liver damage usually proceeds along a common route, causing chronic inflammation, the death of formerly healthy liver tissue and its replacement by scar tissue. This process is called fibrosis. If the underlying cause of chronic liver disease is left untreated, the scarring eventually spreads throughout the liver and this vital organ becomes increasingly dysfunctional. This can lead to serious health complications, including in some cases, liver cancer.
Assessing fibrosis is important so that doctors and their patients can keep abreast of changes to this organ and determine if interventions to improve the health of the liver are having an effect. In the case of ALD and NAFLD, such interventions are behavioural, including cutting back on alcohol and incorporating exercise into daily routines. In the cases of viral infections -- HBV and HCV -- interventions include treatment with antiviral medicines.
Historically, the most highly regarded way of assessing liver fibrosis has been a liver biopsy -- a procedure that involves removing a tiny piece of the liver for laboratory analysis. This procedure can be done relatively quickly. However, liver biopsies can have drawbacks:
There are several non-invasive means of assessing the degree of fibrosis in the liver, which are largely dependent on blood tests. These include:
Tests that evaluate the physical state of the liver, or stiffness of the liver, can also assess injury. These include:
No liver assessment technique or technology is perfect; each one has advantages and disadvantages. However, care and treatment guidelines across high-income regions in North America and Western Europe increasingly call for the use of non-invasive means for assessing liver health. As a result, researchers at McGill University and the University of Calgary were interested in determining how non-invasive technologies were being used to assess damage to the liver. The researchers developed an internet-based survey, which was disseminated with the help of scientific societies such as the Canadian Association of Gastroenterologists (CAG) and the CIHR Canadian HIV Trials Network (CTN). The survey asked doctors who cared for patients with chronic liver disease detailed questions about what they used to assess liver injury in patients.
The researchers found that the use of liver biopsy was still relatively common -- nearly 46% of participants reported using it. However, researchers stated that "non-invasive methods, particularly Fibroscan, have significantly reduced the need for liver biopsy in Canada." Further findings from the survey appear later in this CATIE News bulletin.
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