Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL).
Liver fibrosis is a common pathway leading to cirrhosis, which is the final result of injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Liver biopsy has been considered to be the "gold standard" to assess fibrosis. However, liver biopsy being invasive and, in many instances, not favored by patients or physicians, alternative approaches to assess liver fibrosis have assumed great importance. Moreover, therapies aimed at reversing the liver fibrosis have also been tried lately with variable results. Till now, there has been no consensus on various clinical, pathological, and radiological aspects of liver fibrosis. The Asian Pacific Association for the Study of the Liver set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The process for the development of these consensus guidelines involved the following: review of all available published literature by a core group of experts; proposal of consensus statements by the experts; discussion of the contentious issues; and unanimous approval of the consensus statements after discussion. The Oxford System of evidence-based approach was adopted for developing the consensus statements using the level of evidence from 1 (highest) to 5 (lowest) and grade of recommendation from A (strongest) to D (weakest). The consensus statements are presented in this review.
Shiha
Gamal
G
GI and Liver Unit, Internal Medicine Department, Almansoura Faculty of Medicine, Almansoura University, Almansoura, 35516, Egypt, g_shiha@hotmail.com.
Sarin
Shiv Kumar
SK
Ibrahim
Alaa Eldin
AE
Omata
Masao
M
Kumar
Ashish
A
Lesmana
Laurentius A
LA
Leung
Nancy
N
Tozun
Nurdan
N
Hamid
Saeed
S
Jafri
Wasim
W
Maruyama
Hitoshi
H
Bedossa
Pierre
P
Pinzani
Massimo
M
Chawla
Yogesh
Y
Esmat
Gamal
G
Doss
Wahed
W
Elzanaty
Taher
T
Sakhuja
Puja
P
Nasr
Ahmed Medhat
AM
Omar
Ashraf
A
Wai
Chun-Tao
CT
Abdallah
Ahmed
A
Salama
Mohsen
M
Hamed
Abdelkhalek
A
Yousry
Ayman
A
Waked
Imam
I
Elsahar
Medhat
M
Fateen
Amr
A
Mogawer
Sherif
S
Hamdy
Hassan
H
Elwakil
Reda
R