Is FibroScan® as Effective as Biopsy or MR in Quantifying Liver Disease in Diabetes?
Louise Elizabeth Edwards | University of Warwick
The incidence of NAFLD and NASH is rising and liver disease is one of the largest causes of death in 35-49 year-olds in the UK. NAFLD and diabetes mellitus often coexist, especially with increasing prevalence of metabolic syndrome. FibroScan, is an investigative tool for liver fibrosis in NAFLD and other chronic liver disease, it requires minimal operator training and exhibits reduced sampling error when compared to liver biopsy, making it a readily accessible option.
Databases were searched on 2 occasions, papers from January 1980 to April 2020 were included. Full text review was carried out on 177 papers. Due to insufficient papers including the comparison of FibroScan and MR, analysis focused on the comparison of FibroScan and biopsy only.
Prevalence of NAFLD was between 2.7% and 100%. The number of patients excluded due to insufficient LSM or CAP acquisition ranged from 0 to 50%. FibroScan failure rates varied across papers, those investigating T2DM patients reported no FibroScan failures. Discordance was reported in up to 13.4% of patients. There was a lack of consensus in the data for a particular LSM for a corresponding histological fibrosis stage.
On its own FibroScan is able to accurately identify significant steatosis and fibrosis, currently it is not robust enough to grade the stages of NAFLD. With further research FibroScan in combination with other non-invasive screening tests, could be used to rule out a large proportion of patients that are not high risk, and help clinicians refer those who need it most to specialist clinics.
(Abbreviations: CAP = controlled attenuated parameter, LSM = liver stiffness measurement, MR = magnetic resonance, NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis)
The role of gut-microbiome targeted therapies in the management of non-alcoholic fatty liver disease: a systematic review and meta-analysis
Sophie Hopkins | University of Warwick
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world. Pre-clinical evidence suggests that gut microbiome-targeted therapies (MTTs) may represent a new therapeutic target for the condition. The aim of this research was to evaluate the current evidence supporting the role of MTTs in the management of NAFLD.
The electronic databases MEDLINE, EMBASE and Web of Science were searched. Randomised controlled trials that compared MTTs with placebo or usual care in patients with NAFLD were eligible for inclusion. MTTs were defined as probiotics, prebiotics, synbiotics, antibiotics and faecal microbiota transplantation. A random effects meta-analysis was performed, and statistical heterogeneity was assessed using I2. If identified, this was explored using univariable meta-regression analysis.
12 studies were identified. 8 reported a significant reduction in hepatic steatosis following MTTs. MTTs were associated with a significant reduction in alanine aminotransferase (ALT) (WMD: -6.96 IU/L, 95% CIs: -11.78,-2.14) and aspartate aminotransferase (AST) (WMD: -6.52, 95% CIs: -12.05,-0.99) compared to control. However, significant heterogeneity between studies was reported (ALT: I2 = 98.66%, AST: I2 = 99.60%). For ALT, meta-regression revealed mean age at baseline was significantly associated with treatment effect estimate (p=0.010). MTTs were not associated with a significant reduction in body mass index (BMI) (WMD: -0.27 kg/m2, 95% CIs: -0.62,0.08 kg/m2).
MTTs were associated with a significant reduction in hepatic steatosis and liver function markers, but not BMI. Although promising, significant heterogeneity between studies means the results are difficult to interpret.