Histological progress of non-alcoholic fatty liver disease: a critical reassessment based on liver sampling variability.
2007 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, Vol. 26, 821-830 p.Article in journal (Refereed) Published
Background: In non-alcoholic fatty liver disease, histological lesions display a significant sampling variability that is ignored when interpreting histological progression during natural history or therapeutic interventions. Aim: To provide a method taking into account sampling variability when interpreting crude histological data, and to investigate how this alters the conclusions of available studies. Methods: Natural history studies detailing histological progression and therapeutic trials were compared with the results of a previously published sampling variability study. Results: Natural history studies showed an improvement in steatosis, which was significantly higher than expected from sampling variability (47% vs. 8%, P < 0.0001). In contrast, no study showed a change in activity grade or ballooning higher than that of sampling variability. There was only a marginal effect on fibrosis with no convincing demonstration of a worsening of fibrosis, a conclusion contrary to what individual studies have claimed. Some insulin sensitizing drugs and anti-obesity surgery significantly improved steatosis, while most did not significantly impact on fibrosis or activity. Conclusions: Sampling variability of liver biopsy is an overlooked confounding factor that should be considered systematically when interpreting histological progression in patients with non-alcoholic fatty liver disease.
Place, publisher, year, edition, pages
2007. Vol. 26, 821-830 p.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-39107DOI: 10.1111/j.1365-2036.2007.03425.xLocal ID: 46585OAI: oai:DiVA.org:liu-39107DiVA: diva2:259956