Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3238
Peer-review started: October 24, 2020
First decision: November 25, 2020
Revised: December 6, 2020
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 21, 2021
Non-alcoholic fatty liver disease (NAFLD), is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation, known as nonalcoholic steatohepatitis. Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma (HCC). Fatty liver disease prevalence has increased at alarming rates alongside obesity, diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide. Given this rise in prevalence, it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis. Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease. This article discusses the utility of current non-invasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available. Additionally, we summarize available treatment options including targeted medical therapy through four different pathways, surgical or endoscopic intervention.
Core Tip: Fatty liver disease rates along with obesity, diabetes and metabolic syndrome continue to increase and now is the second leading cause of cirrhosis secondary to alcohol related liver disease. The need for consistent and readily available methods to accurately diagnose and stage hepatic fibrosis becomes increasingly necessary. With an up to date armamentarium to diagnose and treat the full spectrum of non-alcoholic fatty liver disease will decrease complications such as cirrhosis and hepatocellular carcinoma and will improve the likelihood for patients to have a higher quality of life.