Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2015; 21(21): 6444-6450
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6444
Controversy in the diagnosis of pediatric non-alcoholic fatty liver disease
Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice
Pierluigi Marzuillo, Anna Grandone, Laura Perrone, Emanuele Miraglia del Giudice, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, 80138 Naples, Italy
Author contributions: Marzuillo P wrote the manuscript; Grandone A and Perrone L supervised the manuscript drafting; Miraglia del Giudice E conceived the manuscript.
Conflict-of-interest: The authors have nothing to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emanuele Miraglia del Giudice, Professor, Department of women and children and general and specialized surgery, Seconda Università degli Studi di Napoli, Via L. De Crecchio 2, 80138 Naples, Italy. emanuele.miraglia@unina2.it
Telephone: +39-08-15665420 Fax: +39-08-15665427
Received: January 13, 2015
Peer-review started: January 13, 2015
First decision: March 10. 2015
Revised: March 26, 2015
Accepted: May 4, 2015
Article in press: May 4, 2015
Published online: June 7, 2015
Abstract

In the last years childhood obesity has reached epidemic diffusion with about 200 million school-age children worldwide being overweight or obese. Simultaneously, also the prevalence of obesity comorbidities has been increased and the non-alcoholic fatty liver disease (NAFLD) has become the most common form of liver disease in childhood. Also if there are some not-invasive diagnostic possibilities, the diagnostic gold standard is represented by hepatic biopsy giving to the clinicians the possibility to both diagnose the NAFLD and evaluate its progression to fibrosis or cirrhosis with greater certainty than other techniques. The use of liver biopsy in clinical practice causes debate among health care providers. Most patients with NAFLD have a good prognosis and, therefore, the risks of a liver biopsy seem to outweigh the clinical benefits. It represents an impractical screening procedure because it is both expensive and invasive and, moreover, sampling error of liver biopsy can result in substantial misdiagnosis and staging inaccuracies because histological lesions of non-alcoholic steatohepatitis are unevenly distributed throughout the liver parenchyma. The liver biopsy limitations have led the clinicians to use, also if highly imperfect, non-invasive methods to diagnose and stage NAFLD. In this editorial the main diagnostic controversies in pediatric NAFLD are examined.

Keywords: Pediatric, Non-alcoholic fatty liver disease, Biopsy, Liver, Ultrasound, Alanine transaminase

Core tip: Because of the rising obesity prevalence, the non-alcoholic fatty liver disease (NAFLD) has become the most common form of liver disease in childhood. The diagnostic gold standard is represented by hepatic biopsy but the use of liver biopsy in clinical practice causes debate among health care providers because most patients with NAFLD have a good prognosis and, therefore, the risks of a liver biopsy seem to outweigh the clinical benefits. The liver biopsy limitations have led the clinicians to use non-invasive methods to diagnose and stage NAFLD. In this editorial the main diagnostic controversies in pediatric NAFLD are examined.