The enhanced liver fibrosis (ELF) test in diagnosis and management of liver fibrosis.

Liver disease is a major cause of mortality both globally and in the UK. The earlier liver fibrosis is detected, the sooner interventions can be implemented, including lifestyle changes and medications. Non-invasive tests for liver fibrosis are beginning to augment and replace liver biopsy in assessment of liver fibrosis because of their ease of use, lack of complications and reproducibility. The enhanced liver fibrosis (ELF) test is a blood test that measures three molecules involved in liver matrix metabolism to give a score reflecting the severity of liver fibrosis. This article reviews the evidence supporting ELF as a diagnostic test, a prognostic marker and its use in disease monitoring. In doing so it highlights the important role ELF plays in the early recognition of liver fibrosis facilitating timely referral to a liver specialist. The ELF test is useful in primary, secondary and tertiary care, not only allowing earlier diagnosis and more accurate prognosis, but also providing the opportunity to personalize treatment based on the patient's response.