Assessment of prognosis in alcoholic liver disease: can serum hyaluronate replace liver biopsy?

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  Only 15–20% of chronic alcohol misusers ever develop cirrhosis.

  Currently it is not possible to predict clinically who will develop progressive fibrotic alcoholic liver disease.

  Liver biopsy is currently the gold standard diagnostic test in alcoholic liver disease, but it has associated morbidity and mortality.

  Serum hyaluronic acid is a simple non-invasive test that may be able to give an estimate of the severity of fibrosis in alcoholic liver disease.

The full clinical assessment of alcoholic liver disease includes liver biopsy, since accurate clinical prediction of the severity of liver damage is extremely difficult in all except very advanced cases. Unfortunately, liver biopsy has an associated complication rate and is contraindicated in, or unacceptable to, some patients. A reliable non-invasive test of the severity of fibrotic disease would be clinically useful at initial clinical assessment in some patients with alcoholic liver disease. Such a test would be more useful in subsequent monitoring of disease progression, and in particular may diminish the need for follow-up liver biopsy. Serum hyaluronic acid has been put forward as such a non-invasive test. Based on current evidence, serum hyaluronic acid may well be a useful adjunctive test in the assessment of certain categories of alcoholic liver disease patients, but at present it is unlikely to displace liver biopsy as the investigation of choice in alcoholic liver disease.

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