title: Non-invasive diagnosis of alcoholic liver disease.
abstract: Alcoholic liver disease (ALD) is the most common liver disease in the Western world. For many reasons, it is underestimated and underdiagnosed. An early diagnosis is absolutely essential since it (1) helps to identify patients at genetic risk for ALD; (2) can trigger efficient abstinence namely in non-addicted patients; and (3) initiate screening programs to prevent life-threatening complications such as bleeding from varices, spontaneous bacterial peritonitis or hepatocellular cancer. The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis (AH). The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on a combination of laboratory, clinical and imaging findings. It is not widely conceived that conventional screening tools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca. 40% of manifest alcoholic liver cirrhosis. Non-invasive methods such as transient elastography (Fibroscan), acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholic cirrhosis. Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca. 95% of patients. The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels. Other non-invasive methods such as controlled attenuation parameter, serum levels of M30 or M65, susceptometry or breath tests are under current evaluation to assess the degree of steatosis, apoptosis and iron overload in these patients. Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.
authors.affiliation: Sebastian Mueller, Helmut Karl Seitz, Department of Internal Medicine, Salem Medical Center, University of Heidelberg, 69121 Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Sebastian Mueller, Helmut Karl Seitz, Department of Internal Medicine, Salem Medical Center, University of Heidelberg, 69121 Heidelberg, Germany.
authors.forename: Helmut Karl
authors.initials: HK
authors.lastname: Seitz
authors.affiliation: Sebastian Mueller, Helmut Karl Seitz, Department of Internal Medicine, Salem Medical Center, University of Heidelberg, 69121 Heidelberg, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rausch
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods; D042241:Early Diagnosis; D054459:Elasticity Imaging Techniques; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: Alcoholic hepatitis; Alcoholic liver disease; Alcoholic steatohepatitis; Liver stiffness; Non-invasive; Serum marker; Steatosis