title: Non-invasive monitoring of liver fibrosis.
abstract: BACKGROUND
  Assessing the formation and regression of fibrosis in chronic liver disease (CLD) is important. Current methods of assessment employed in clinical practice are inadequate. We present a review of the utility of non-invasive biomarkers of liver fibrosis.
  
  
  METHODS
  Published material on MEDLINE.
  
  
  RESULTS
  Liver biopsy is an imperfect 'gold standard'. Biomarkers are excellent at detecting significant fibrosis across different aetiologies of CLD. There is growing evidence that they also predict clinical outcomes.
  
  
  RESULTS
  Non-invasive biomarkers can be used in clinical practice to screen for significant fibrosis, but the utility of liver biopsy is retained in answering specific questions. Biomarkers cannot be used robustly in clinical trials as doubts remain over their ability to detect small changes in fibrosis, inflammation and what influences them.
  
  
  CONCLUSIONS
  Community screening and algorithms are being developed with biomarkers to more effectively direct resources. Novel imaging techniques have huge potential advantages, particularly in secondary care for risk stratification.
authors.affiliation: National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit (NDDBRU), Nottingham University Hospitals NHS Trust and University of Nottingham, E Floor, West Block QMC, Queen's Medical Centre, Nottingham NG7 2UH, UK robertscott@doctors.org.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Scott
authors.affiliation: National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit (NDDBRU), Nottingham University Hospitals NHS Trust and University of Nottingham, E Floor, West Block QMC, Queen's Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Indra Neil
authors.initials: IN
authors.lastname: Guha
mesh_terms: D015415:Biomarkers / Q000097:blood; D035843:Biomedical Research / Q000379:methods / Q000639:trends; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*
chemical_list: D015415:Biomarkers
keywords: biomarkers; cirrhosis; fibrosis; imaging; review