Clinical practice update offers recommendations on noninvasive testing for NAFLD

A clinical practice update from the American Gastroenterological Association provides clinicians with guidance on the use of noninvasive tests in the evaluation and management of nonalcoholic fatty liver disease (NAFLD).

It is critically important to assess patients with increased risk of disease progression and negative clinical outcomes, as well as disease trajectory over time, the update stated. While liver biopsies are the reference standard, they have limitations in their use, and noninvasive tests can help with risk stratification and longitudinal assessment of disease progression. The clinical update, which provides eight items of best practice advice, was published Aug. 4 in Gastroenterology.

The best practice advice statements are as follows:

1. 1. Noninvasive tests can be used for risk stratification in the diagnostic evaluation of patients with NAFLD.
2. 2. A Fibrosis-4 (FIB-4) Index score less than 1.3 is associated with strong negative predictive value for advanced hepatic fibrosis and may be useful for exclusion of advanced hepatic fibrosis in patients with NAFLD.
3. 3. Two or more serum and/or imaging-based biomarkers are preferred for staging and risk stratification of patients with NAFLD whose FIB-4 is greater than 1.3.
4. 4. Following manufacturers' specifications for noninvasive testing can minimize risk of discordant results and adverse events.
5. 5. Noninvasive tests should be interpreted with context and consideration of pertinent clinical data to optimize positive predictive value.
6. 6. Liver biopsy should be considered for patients with results that are indeterminate or discordant or conflict with other clinical, laboratory, or radiologic findings, or when other causes of liver disease are suspected.
7. 7. Serial longitudinal monitoring with noninvasive testing for assessment of disease progression or regression may help clinical management.
8. 8. Patients with NAFLD and noninvasive testing results indicating advanced fibrosis or cirrhosis should be considered for surveillance of liver complications, and those with results suggesting advanced fibrosis or cirrhosis should be monitored with serial liver stiffness measurement, vibration-controlled transient elastography, or magnetic resonance elastography.

“The health care burden of longitudinal management of patients with NAFLD is significant,” the update concluded. “The emergence and utilization of [noninvasive tests] in gastroenterology practices has the potential to significantly enhance the care of patients with NAFLD by improving detection of patients with [advanced fibrosis] who are at increased risk for cirrhosis, hepatic decompensation, and [hepatocellular carcinoma], thereby facilitating timely clinical management.”