Introduction:
Non-alcoholic fatty liver disease (NAFLD) is an important public health concern. It is the most prevalent chronic liver disease in the general population, and as the population ages, it is predicted to become more prevalent in the future. The gold standard for identifying the wide spectrum of NAFLD is still liver biopsy. However, due to their expense, possible bleeding risk, and lack of agreement on the histological criteria that clearly distinguish between the various NAFLD entities, liver biopsies are frequently not advised in patients with NAFLD. A non-invasive, straightforward, and repeatable approach is required in clinical practice because of the extraordinary rise in the prevalence of non-alcoholic fatty liver disease (NAFLD) and the concurrent efforts to discover innovative therapeutics. Transient Elastography is a non-invasive method for measuring liver stiffness (LSM) in relation to the degree of hepatic fibrosis (formation of excess connective tissue in the liver). This review identifies topics for further study and advancement and focuses on practical concerns with the use of LSM in NAFLD patients.
What Is Pediatric Nonalcoholic Fatty Liver Disease?
The most prevalent kind of chronic liver disease in children and adolescents is nonalcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease or MASLD. It happens when the liver is too fat. Direct food intake from the stomach is processed by the liver into energy and other proteins by turning fat, carbs, and protein. Excess fat may enter the liver cells due to an imbalance in this mechanism.
Currently known as metabolic dysfunction-associated steatotic liver disease, nonalcoholic fatty liver disease is a collection of disorders that manifest at varying stages:
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Simple Steatosis: It is the accumulation of fat in the liver.
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Nonalcoholic Steatohepatitis (NASH): Currently, it is known as metabolic dysfunction associated with steatohepatitis, or MASH. Nonalcoholic steatohepatitis (NASH) is inflammation (liver swelling) brought on by fat accumulation.
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NASH With Fibrosis: It is caused by liver scarring.
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Cirrhosis: Uneven nodules and liver stiffening, typically as a result of chronic injury.
In the early stages, NAFLD in children is asymptomatic. Nonetheless, some kids may feel lethargic, have stomach pains, or have their liver enlarged. It is possible that symptoms will not show up until the illness has advanced. The treatment usually involves lifestyle changes, such as maintaining a healthy weight, exercising frequently, eating a balanced diet, and limiting sugary and fatty foods. It is also critical to monitor and treat related illnesses like diabetes and obesity.
What Is Transient Elastography?
A non-invasive medical technique called transient elastography (TE) is used to measure the liver's elasticity and stiffness. It is mostly used to identify liver fibrosis, a disorder in which the liver develops an excessive amount of scar tissue as a result of a number of liver illnesses, including cirrhosis, fatty liver disease, and hepatitis. A specialized ultrasonic probe is gently positioned on the skin's surface above the liver during a transient elastography exam. Low-frequency sound waves released by the probe cause a vibration that spreads throughout the liver tissue. The assessment of the speed of these waves aids in determining the stiffness of the liver. The principle underlying Transient Elastography is that the liver tissue damaged by fibrosis or scarring tends to be stiffer, while healthy liver tissue is more elastic and flexible. The results, which represent the stiffness of the liver, are usually shown as a numerical number. Without the necessity for a biopsy, which is a more intrusive technique, this value can help medical practitioners assess the extent of liver damage and determine the existence and stage of liver illnesses.
What Are the Advantages of Transient Elastography?
For NAFLD, ultrasound is still the preferred imaging modality, as it can frequently show the liver's distinctive fatty deposits. However, fibrosis cannot be accurately estimated by ultrasonography alone. The capacity of TE to evaluate hepatic stiffness provides an additional vital layer of data, aiding in:
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Proper Diagnosis: Helps in differentiating between NAFLD and simple fatty liver. TE can help distinguish mild fat gain from potentially serious fibrosis associated with NAFLD.
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Identification of High-Risk Patients: Determine which kids are more vulnerable to problems. An increased risk of NAFLD-related consequences, such as liver failure and cirrhosis, is correlated with higher LSM levels. Timely intervention is made possible by early detection.
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Personalized Care: Based on each child's unique risk profile and illness severity, TE-based risk stratification can inform treatment recommendations that are specifically designed for them.
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Non-invasive Monitoring: Without the need for recurrent biopsies, serial TE measurements can monitor the course of a disease and its response to therapy, improving patient comfort and compliance.
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Follow-up and Planning: Follow the course of the illness and the success of therapy. Repeated TE measures can quantify changes in liver stiffness over time, providing valuable information for treatment planning and assessing the efficacy of medicine or lifestyle changes.
What Are the Challenges of Transient Elastography?
Even though TE is excellent at diagnosing NAFLD in adults, there are several factors to take into account when interpreting findings in children:
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Growth and Development: In youngsters, liver stiffness always rises with age and body size. TE reference values designed especially for pediatric populations are essential for a correct diagnosis.
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Technical Limitations: The probe size and application method must be adjusted for smaller bodies to provide accurate measurements.
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Comorbid Conditions: Children with coexisting illnesses may have changed liver stiffness for reasons unrelated to nonalcoholic fatty liver disease. This may make it more difficult for TE to diagnose NAFLD in these particular situations accurately.
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Operator Dependency: The operator's experience and skill may impact the accuracy of TE measurements. It takes expertise to obtain consistent and trustworthy measurements, and differences in operator proficiency might impact the accuracy of the findings.
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Other influences: Inflammation and ascites (fluid buildup in the abdomen) are two factors that might impact TE outcomes in children. Hence, careful clinical interpretation is required in addition to other studies.
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Restricted Availability: Not all pediatric healthcare settings have widespread access to TE, which makes it less useful for diagnosis in some areas or medical institutions.
Conclusion:
A liver biopsy is considered a gold standard for determining the degree and severity of liver fibrosis in Pediatric non-alcoholic fatty liver disease. Lately, it has several drawbacks, including its invasiveness, high expense, requirement for clinical competence, and relatively high complication rates. Critically sick individuals may experience more severe repercussions from these conditions. Hence, it is advisable to employ non-invasive, readily reproducible assays, such as TE, to assess liver fibrosis. These assays offer a viable substitute for more intrusive testing and may be helpful in staging and monitoring fibrosis and its associated consequences.
