Non-alcoholic fatty liver disease has emerged as one of the more important clinical problems being faced by primary care clinicians and hepatologists and is estimated to affect 20-30% of our population. Closely linked to metabolic syndrome, insulin resistance and diabetes, an increasing prevalence of this condition mirrors the rising average BMI of western societies. Decompensated cirrhosis requiring intensive medical management or transplantation and or hepatocellular carcinoma development are all possible sequelae. In one British study in 2008, 12% of patients waiting for transplantation had cirrhosis from NASH. About 11% of NASH patients ultimately are at high risk of death from liver-related illness. Liver hardness may be evaluated using a Fibroscan which measures the velocity of an induced vibration wave (the ‘shear wave’) generated on the skin by a non-invasive probe and checks the time the vibration wave takes to travel to a particular depth inside the liver. Because fibrous tissue is harder than normal liver, the degree of hepatic fibrosis can be inferred from the liver hardness. As more fibrosis and scarring occur, the higher the liver stiffness reading will be. Taking about ten minutes the test is very useful in the assessment of patients with all forms of chronic liver disease not just fatty liver including chronic hepatitis C, chronic hepatitis B and chronic alcohol abuse. By providing an estimate of the existing degree of liver damage fibre scanning enables accurate non-invasive monitoring of disease progression or regression via serial measurements. This information is helpful in gauging prognosis and in helping determine further management strategies. Results are expressed in kilopascals (kPa). Fibroscan results may range from 2.5 kPa to 75 kPa. Between 90 –95% of healthy people without liver disease will have a shear wave measurement of 14 kPa has approximately a 90% probability of having cirrhosis, while patients with liver stiffness >7 kPa have around an 85% probability of at least significant fibrosis. Fibroscan measurements now play an important role in liver disease assessment and management, consequently the utility of the Fibroscan has become an essential part of the diagnostic tool kit widely relied upon by hepatologists. I was keen to explore this topic in more detail with our guest Michael Braude who has just completed a PhD exploring liver disease and mental health and is currently involved in establishing a fully integrated metabolic fatty liver clinic at Monash Health bringing his own enthusiasm and intellect to this well-needed community service… Please welcome Michael to the podcast References: Dr Michael Braude: www.gihealth.com.au,monashhealth.org Nonalcoholic Fatty Liver Disease: www.niddk.nih.gov Fibroscan and transient elastography: www.racgp.org.au To be a guest on the show or provide some feedback, I’d love to hear from you: [email protected] Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.