This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Diagnosis  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: We agree with Dr Yanai and Ms Morimoto that potential sampling error, risk of complications, and expense limit the widespread application of liver biopsy to stage fibrosis in patients with chronic liver diseases, including NAFLD. These inadequacies have motivated the search for noninvasive markers of hepatic fibrosis. No single test, whether invasive or noninvasive, can establish the extent of liver fibrosis. Indeed, the article by Dienstag,¹ which Yanai and Morimoto cite, concludes that noninvasive markers of hepatic fibrosis are "insufficiently reliable to predict histological distinctions in populations with varying prevalence of fibrosis/cirrhosis or to provide anything more than broad qualitative distinctions, far short of the potential information in a liver biopsy." Similarly, Fontana and Lok² concluded that individual serum fibrosis markers have "limited accuracy" and that panels of markers "require further validation." Marcellin et al³ reported that "serum markers for fibrosis are not reliable and need to be . . . [Full Text of this Article]

Jeanne M. Clark, MD, MPH
Departments of Medicine and Epidemiology

Anna Mae Diehl, MD
Department of Medicine
Johns Hopkins University
Baltimore, Md

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Diagnosis of Nonalcoholic Fatty Liver Disease
Hidekatsu Yanai and Mie Morimoto
JAMA. 2003;290(12):1577.
EXTRACT | FULL TEXT