Non-invasive monitoring of liver fibrosis.

INTRODUCTION: 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. SOURCES OF DATA: Published material on MEDLINE. AREAS OF AGREEMENT: 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. AREAS OF CONTROVERSY: 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. AREAS TIMELY FOR DEVELOPING RESEARCH: 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.