In addition to today’s article, please review Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Gastroenterology. 2021 Nov;161(5):1657-1669. doi: 10.1053/j.gastro.2021.07.049. Epub 2021 Sep 20.
Abstract
Find AGA’s NASH Clinical Care Pathway App for iOS and Android mobile devices at nash.gastro.org. Scan this QR code to be taken directly to the website.Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common, currently affecting approximately 37% of US adults. NAFLD is most often managed in primary care or endocrine clinics, where clinicians must determine which patients might benefit from secondary care to address hepatic manifestations, comorbid metabolic traits, and cardiovascular risks of the disease. Because NAFLD is largely asymptomatic, and because optimal timing of treatment depends on accurate staging of fibrosis risk, screening at the primary care level is critical, together with consistent, timely, evidence-based, widely accessible, and testable management processes. To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2-F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices.
Keywords: Clinical Care Pathway; Liver Disease; NAFLD; NASH; Nonalcoholic Fatty Liver Disease; Nonalcoholic Steatohepatitis.
Today, I review, link to, and excerpt from Transient Elastography and Fibroscan: Stethoscope of a Hepatologist in Today’s World [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Curr Hepatol Rep. 2025 Dec;24(1):10.1007/s11901-025-00713-7. doi: 10.1007/s11901-025-00713-7. Epub 2025 Nov 27.
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All that follows is from the above article.
- Abstract
- Introduction
- Vibration-Controlled Transient Elastography: General Principles
- Role of VCTE in Fibrosis Assessment
- Use of VCTE for the Assessment of Chronic Liver Diseases
- Role of VCTE in Special Populations
- Novel Applications of Transient Elastography
- Conclusion
- Funding
- Footnotes
- Data Availability
- References
- Associated Data
Abstract
Purpose of Review
Vibration-controlled transient elastography (VCTE) has become a cornerstone in the noninvasive assessment of liver disease across etiologies. This review highlights its role in risk stratification and longitudinal monitoring, emphasizing its value in both clinical practice and research settings, including community and academic hepatology.
Recent Findings
VCTE reliably assesses liver fibrosis severity and clinically significant portal hypertension and enables ongoing monitoring of therapeutic response. It also predicts liver-related events and mortality. Recognizing its limitations and potential confounders is essential to ensure diagnostic accuracy, and its performance can be further enhanced by integrating clinical and biochemical variables.
Summary
Despite inherent limitations, improvements in probe design, standardized protocols, and composite algorithms have expanded its clinical utility. The 2022 Baveno consensus established clear guidance for using VCTE to identify clinically significant portal hypertension, ultimately aiming to prevent first decompensation and improve patient outcomes.
Keywords: Vibration controlled transient elastography (VCTE), Non-invasive test (NIT), Compensated advanced chronic liver disease (cACLD), Clinically significant portal hypertension (CSPH), Liver fibrosis measurement (LSM)
