Since liver diseases represent a huge problem for the health care systems and the population, the diagnostic methods in hepatology are an important field for research and the development of new techniques and thus a market for the medical industry.
One of the biggest problems is the early diagnosis of chronic liver diseases by which a big group of people is infected. Alone 350 million people by chronic HBV and about 170 million by Hepatitis C. 25,000,000 Americans - one in every 10 - are afflicted with liver-related diseases each year. Another problem is the early differential diagnosis of acute liver diseases, although these affect a much smaller group of patients.
Today, there are some common procedures for diagnosis of liver diseases. At the beginning lies a physical examination, then liver function tests might be used to assess the capability of the liver to cope with toxins. Given the case of hepatitis an antibody test with a blood sample can be helpful. However, today, for many diseases, especially chronic ones and cirrhosis, the only way of diagnosis used is a liver biopsy.
Since a liver biopsy is a surgical with a death rate of 1 per 10,000, the aim should be to substitute it with other, less invasive, diagnostic techniques. In the last years big progress has been made in the field of liver diagnostic and new techniques have been introduced. Some of these are:
- Fibrosis and Activity Tests, which use biochemical markers to determine the degree of fibrosis. They could be an alternative to biopsy in the diagnosis of NASH, HBV or HCV.
- Indocyanine Green Elimination is measured in another test. This technique has a broad field of use in chronic liver diseases, pediatric liver diseases and acute liver failures.
- Other tests that could be an alternative to liver biopsy are Breath Tests, a Functional Liver Detoxification Profile (FLDP) or Serum Metal Levels.
- Noninvasive liver test for NASH - Measuring plasma levels of cytokeratin-18 fragments (CK-18) might be a noninvasive liver test to differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis or normal tissue. Hepatocyte apoptosis characterizes NASH, and in late stages of this liver disease, activated caspases cleave CK-18, the major intermediate filament protein in the liver. Such a noninvasive liver test may aid clinicians in the selection of patients for liver biopsy and might also allow for noninvasive assessment of liver disease progression and therapeutic response.
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