Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2020; 26(39): 5919-5943
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.5919
Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease
Alejandro Campos-Murguía, Astrid Ruiz-Margáin, José A González-Regueiro, Ricardo U Macías-Rodríguez
Alejandro Campos-Murguía, Astrid Ruiz-Margáin, José A González-Regueiro, Ricardo U Macías-Rodríguez, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Author contributions: Macías-Rodríguez RU contributed to conception and design of the review; Campos-Murguía A, Ruiz-Margáin A, González-Regueiro JA and Macías-Rodríguez RU contributed with literature review, writing and analysis of data; Campos-Murguía A, Ruiz-Margáin A and Macías-Rodríguez RU contributed with drafting, critical revision, supervision and editing of the content of the manuscript; Campos-Murguía A, Ruiz-Margáin A, González-Regueiro JA and Macías-Rodríguez RU contributed to writing the final version of the manuscript.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Ricardo U Macías-Rodríguez, MD, MSc, PhD, Assistant Professor, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Liver Fibrosis and Nutrition lab (LFN-Lab). MICTLÁN Network: mechanisms of liver injury, cell death and translational nutrition in liver diseases-research network. Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Mexico City 14080, Mexico. ricardomacro@yahoo.com.mx
Received: May 15, 2020
Peer-review started: May 15, 2020
First decision: May 21, 2020
Revised: May 24, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: October 21, 2020
Processing time: 158 Days and 23.5 Hours
Abstract

Non-alcoholic fatty liver disease (NAFLD) is among the most frequent etiologies of cirrhosis worldwide, and it is associated with features of metabolic syndrome; the key factor influencing its prognosis is the progression of liver fibrosis. This review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD, analyzing the currently available literature. In the assessment of NAFLD patients, it is important to identify clinical, genetic, and environmental determinants of fibrosis development and its progression. To properly detect fibrosis, it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores, followed by a complementary imaging study (transient elastography, magnetic resonance elastography or acoustic radiation force impulse) and finally a liver biopsy, when needed. To help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review, describing the diagnostic yield of each method and their post-test probability of detecting liver fibrosis. Finally, treatment should always include diet and exercise, as well as controlling the components of the metabolic syndrome, +/- vitamin E, considering the presence of sleep apnea, and when available, allocate those patients with advanced fibrosis or high risk of progression into clinical trials. The final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD, aiming to decrease/stop its progression and improve their prognosis.

Keywords: Non-alcoholic fatty liver disease; Liver fibrosis; Clinical assessment; Diagnosis; Treatment; Test accuracy

Core Tip: The most important liver-related factor associated with adverse clinical outcomes and mortality in patients with non-alcoholic fatty liver disease (NAFLD) is the presence and progression of fibrosis; its progression depends upon genetic, clinical, and biochemical risk factors, that must be assessed in order to identify patients at risk. To be able to accurately identify fibrosis we must take into account the diagnostic ability of each method and its possible variations according to the local prevalence and the selected cutoffs. This review summarizes the available data on assessment and management of NAFLD with a comprehensive analysis of the current diagnostic methods.