Screening for Liver Disease - are LFTs Old HAT?

The economic burden of end stage liver disease is set to increase due to the rising prevalence of cirrhosis secondary to alcohol, viral hepatitis and fatty liver disease. Screening for liver disease has been advocated, as most cases of cirrhosis are preventable with early interventions. Liver function tests (LFTs) are routinely used as a first line investigation to screen for liver diseases but can be normal despite significant underlying liver fibrosis, hepatitis, steatohepatitis or even cirrhosis. Their relationships are far from linear and with little predictive value in some cases. Newer non-invasive modalities are emerging but currently their roles are largely experimental. This review will discuss the role of serum biomarkers and imaging techniques as new modalities to screen for liver disease.