Despite alcohol-related liver disease (ALD) being a major cause of severe liver disease worldwide, the majority of the patients with ALD are diagnosed at the decompensation stage. The gold standard for establishing a definite diagnosis and assessing the fibrosis stage of ALD remains Liver biopsy is still, but it is an invasive procedure causing marked morbidity. 

Many non-invasive tests have been proposed that estimate the severity of liver fibrosis and steatosis, of which measurement of liver stiffness by transient elastography remains most popular. Transient elastography has demonstrated great potential in detecting advanced fibrosis and cirrhosis in ALD, but additionally, aspartate aminotransferase levels must be taken into account when analysing liver stiffness cut-offs. 

Non-invasive biological tests have also gained popularity in assessing liver fibrosis in ALD, with the Enhanced Liver Fibrosis test and FibroTest being more promising than other biological tests (i.e. FIB-4 and APRI). 

 Ultrasound is still used for initial screening for fatty liver diagnosis, but newer methods have been developed to detect steatosis. Magnetic resonance spectroscopy and magnetic resonance imaging techniques have proven their accuracy and reproducibility, along with superior sensitivities and specificities for detecting histological steatosis than ultrasound. But their use is limited due to low availability and high cost.

 A controlled attenuation parameter has been recently developed as a novel tool to non-invasively assess liver steatosis; functioned in combination with transient elastography. Further, it was found to be superior to regular ultrasound for detecting steatosis with acceptable diagnostic accuracy. 

Recognition of New serum biomarkers is underway to non-invasively diagnose more severe forms of ALD and to predict the prognosis of patients.

Source- Moreno C, Mueller S, Szabo G. Non-invasive diagnosis and biomarkers in alcohol-related liver disease, Journal of Hepatology, 2019;70(2):273-283. https://doi.org/10.1016/j.jhep.2018.11.025.