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A Comprehensive Review of Noninvasive Liver Fibrosis Tests in Pediatric Nonalcoholic Fatty Liver Disease

  • Pediatric Gastroenterology (S Orenstein, Section Editor)
  • Published:
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Abstract

Nonalcoholic fatty liver disease (NAFLD) and its spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis have been increasing in the pediatric population. The presence and severity of fibrosis in patients with NAFLD are important prognostic factors for the risk of disease progression to cirrhosis. The gold standard for staging liver fibrosis is a liver biopsy. However, given the risks of this procedure, especially in the pediatric population, the development of noninvasive markers to diagnose and monitor progression of NAFLD is desirable. This paper will review recently developed noninvasive methods for diagnosing liver fibrosis in children with NAFLD. These include simple fibrosis scores, advanced biochemical markers, and radiologic imaging studies. Simple fibrosis scores use readily available laboratory tests; available one include AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, NAFLD fibrosis score (NFS), pediatric NAFLD fibrosis index (PNFI), and pediatric NALFD fibrosis score (PNFS). Advanced biochemical markers include biomarkers of hepatocyte cell death such as cytokeratin 18 fragment levels, and markers of extracellular matrix turnover such as the Enhanced Liver Fibrosis (ELF) test and hyaluronic acid. Radiologic imaging studies estimate liver stiffness as a surrogate for liver fibrosis; these include transient elastography (TE), magnetic resonance elastography (MRE), and acoustic radiation force impulse imaging (ARFI).

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Conflict of Interest

Sana Mansoor, Elizabeth Collyer, and Naim Alkhouri declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Sana Mansoor, Elizabeth Collyer & Naim Alkhouri

Authors
  1. Sana Mansoor
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  2. Elizabeth Collyer
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  3. Naim Alkhouri
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Corresponding author

Correspondence to Naim Alkhouri.

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This article is part of the Topical Collection on Pediatric Gastroenterology

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Mansoor, S., Collyer, E. & Alkhouri, N. A Comprehensive Review of Noninvasive Liver Fibrosis Tests in Pediatric Nonalcoholic Fatty Liver Disease. Curr Gastroenterol Rep 17, 23 (2015). https://doi.org/10.1007/s11894-015-0447-z

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  • DOI: https://doi.org/10.1007/s11894-015-0447-z

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