Screening and follow‐up of chronic liver diseases with understanding their etiology in clinics and hospitals

BACKGROUND AND AIM: Considering the increasing prevalence of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis (NASH), the development of an effective screening and follow‐up system that enables the recognition of etiological changes by primary physicians in clinics and specialists in hospitals is required. METHODS: Chronic hepatitis B (HBV) and C (HCV), NASH, and alcoholic steatohepatitis (ASH) patients who were assayed for Mac‐2‐binding protein glycosylation isomer (M2BPGi) (n = 272) and underwent magnetic resonance elastography (MRE) (n = 119) were enrolled. Patients who underwent MRE were also tested by ultrasound elastography (USE) (n = 80) and for M2BPGi (n = 97), autotaxin (ATX) (n = 62), and platelet count (n = 119), and their fibrosis‐4 (FIB‐4) index was calculated (n = 119). RESULTS: FIB‐4 index >2, excluding HBV‐infected patients, M2BPGi >0.5, ATX >0.5, and platelet count <20 × 10(4)/μL were the benchmark indices, and we took into consideration other risk factors, such as diabetes mellitus and age, to recommend further examinations, such as USE, based on the local situation to avoid overlooking hepatocellular carcinoma (HCC) in the clinic. During specialty care in the hospital, MRE exhibited high diagnostic ability for fibrosis stages >F3 or F4; it could efficiently predict collateral circulation with high sensitivity, which can replace USE. We also identified etiological features and found that collateral circulation in NASH/ASH patients tended to exceed high‐risk levels; moreover, these patients exhibited more variation in HCC‐associated liver stiffness than the HBV and HCV patients. CONCLUSIONS: Using appropriate markers and tools, we can establish a stepwise, practical, noninvasive, and etiology‐based screening and follow‐up system in primary and specialty care.