Why doctor continues his series on non-alcoholic fatty liver disease. On the agenda of this article: the diagnosis! We talk about it with the hepato-gastroenterologist, Dr. Pauline Guillouche.
- 1 in 5 French people are affected by fatty liver disease. Problem: it is a silent pathology, which is often diagnosed too late.
- However, the diagnosis can be easily made using a blood test and an abdominal ultrasound.
- In the most critical cases, a liver biopsy is sometimes necessary.
Non-alcoholic fatty liver disease is characterized by an accumulation of fats in the liver, apart from any excessive consumption of alcohol. Currently, one in five French people are affected, but the big problem with this pathology is that it is silent. “For years, we feel nothing, there are no signs of illness”, explains Dr. Guillouche. “This often leads to the diagnosis being made late, sometimes at an advanced stage of the disease, and sometimes even at the stage of complications of cirrhosis.”
NASH: can we live with the disease without knowing it?
Several symptoms may appear as the disease develops. “It could be jaundice [jaunisse, NDLR]the development of ascites, i.e. the presence of water in the abdominal cavity, digestive bleeding, unexplained weight loss, intense fatigue, abdominal pain or loss of appetite.” Nevertheless, “it is important not to wait until you have symptoms to be screened”, at the risk of finding yourself at too advanced a stage of the pathology.
Several examinations necessary for diagnosis
With timely treatment, that is to say at the precirrhotic stage, the disease is reversible. This is why it is sought after in people with risk factors such as obesity, type 2 diabetes, metabolic syndrome or even sleep apnea.
“The diagnosis can be made on a liver biopsy, that is to say a sample of a very small piece of the liver during a short anesthesia. Analysis of this biopsy under a microscope will show the presence of steatosis, inflammation and damage to liver cells. But fortunately, we no longer do liver biopsy on everyone because it is an invasive procedure that we will reserve for certain patients under certain conditions.”
Biological tests and abdominal ultrasound can diagnose steatosis and fibrosis. “In a simple blood test, a fibrosis score can be calculated”, says the specialist. This score, the FIB-4, is calculated using transaminases and platelets, and depends on the person’s age. “If it is less than 1.45, there is a 90% chance of not having severe fibrosis, but if it is greater than 3.25 there is, in 65% of cases, severe fibrosis or cirrhosis“, explain the SOS Hépatites association.
Fibroscan measures the elasticity of liver tissue using ultrasound
Doctors also have tools like Fibroscan: “Some latest generation ultrasound devices allow elastography to be performed, that is to say, to quantify the hardness of the liver. These devices use ultrasound, so they are completely painless and identify people with fibrosis simply and safely. They are the ones who are at risk of progressing towards cirrhosis”, specifies Dr. Guillouche.
The Fibroscan is an examination that lasts less than ten minutes. Liver elasticity is measured in kiloPascal (kPa), with a ranking of scores:
-from 2.5 to 7, we are at stage F0 or F1: absence of fibrosis or minimal fibrosis
-from 7.1 to 9.4, we are at stage F2: moderate fibrosis
-from 9.5 to 14, we are at stage F3: severe fibrosis
-beyond 14, we are at stage F4: cirrhosis
