Alcoholic Liver Disease (ALD) therefore represents SU5402 chemical structure a serious public health problem and is likely to get worse in the UK in the coming decades. Clinicians and patients require accurate information about the degree of liver fibrosis in ALD to assess disease severity in order to predict outcome, guide management

decisions and monitor disease. Detection of fibrosis in people drinking hazardously at an early stage or before clinical symptoms of hepatic decompensation could provide opportunities for more optimal management. This is a challenge in a disease process with few characteristic symptoms or signs. The current reference standard to ascertain the stage of fibrosis is histology obtained through liver biopsy. This is an invasive test and subject to limitations both in its acquisition (sampling error, length of biopsy, morbidity and mortality), subsequent analysis (intra and inter observer variability) and inherent drawbacks as a reference standard (ordinal categorical variable representing continuous biological process) [6–8]. In the past decade efforts have been made to find other tests to accurately evaluate fibrosis. Serum selleck chemicals markers of liver fibrosis offer an attractive

alternative to liver biopsy, as they are KU-57788 in vitro less invasive, may allow dynamic calibration of fibrosis, and are potentially more cost effective. Evidence of the diagnostic performance of such serum markers of liver fibrosis in Chronic Liver Disease are needed to assess the clinical utility and effectiveness Fenbendazole of such tests in the diagnosis, prognosis and management of liver disease. Systematic reviews of the diagnostic performance of serum markers in chronic hepatitis C (CHC) and non alcoholic fatty liver disease (NAFLD) have been published but none so far on the evaluation of markers in ALD [9–13]. In order

to provide such evidence, a systematic review was conducted to locate, collate, appraise and analyse studies that evaluated the performance of serum markers in the diagnosis of liver fibrosis in ALD. Methods A systematic literature review was conducted following accepted published principles to ascertain the diagnostic performance of serum markers of liver fibrosis [14]. Sources searched included: Electronic databases 1980 – April 2009 Cochrane Library 2009 Reference lists from relevant articles MEDLINE, EMBASE were searched using a search strategy derived from the literature (search strategy available from authors). Search terms were added following initial searches as appropriate. No authors were contacted for further information.