Singapore Med J. 2018 Dec;59(12):628-633. doi: 10.11622/smedj.2018145.
A practical clinical approach to liver fibrosis.
Kumar R1, Teo EK1, How CH2,3, Wong TY4, Ang TL1.
Author information
1
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
2
Care and Health Integration, Changi General Hospital, Singapore.
3
Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.
4
Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore.
Abstract
Liver fibrosis is a slow, insidious process involving accumulation of extracellular matrix protein in the liver. The stage of liver fibrosis in chronic liver disease (CLD) determines overall morbidity and mortality; the higher the stage, the worse the prognosis. Noninvasive composite scores can be used to determine whether patients with CLD have significant or advanced fibrosis. Patients with low composite scores can be safely followed up in primary care with periodic reassessment. Those with higher scores should be referred to a specialist. As the epidemic of diabetes mellitus, obesity and non-alcoholic fatty liver diseases is rising, CLD is becoming more prevalent. Easy-to-use fibrosis assessment composite scores can identify patients with minimal or advanced fibrosis, and should be an integral part of decision-making. Patients with cirrhosis, high composite scores, chronic hepatitis B with elevated alanine aminotransferase and aspartate aminotransferase, or deranged liver panel of uncertain aetiology should be referred to a specialist.