Liver fibrosis: Consensus recommendations of the Asian Pacific association for the study of the liver (APASL)

Gamal Shiha, Shiv Kumar Sarin, Alaa Eldin Ibrahim, Masao Omata, Ashish Kumar, Laurentius A. Lesmana, Nancy Leung, Nurdan Tozun, Saeed Hamid, Wasim Jafri, Hitoshi Maruyama, Pierre Bedossa, Massimo Pinzani, Yogesh Chawla, Gamal Esmat, Wahed Doss, Taher Elzanaty, Puja Sakhuja, Ahmed Medhat Nasr, Ashraf OmarChun Tao Wai, Ahmed Abdallah, Mohsen Salama, Abdelkhalek Hamed, Ayman Yousry, Imam Waked, Medhat Elsahar, Amr Fateen, Sherif Mogawer, Hassan Hamdy, Reda Elwakil

Research output: Contribution to journalArticlepeer-review

80 Citations (Scopus)


Liver fibrosis is a common pathway leading to cirrhosis, which is the final result of injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Liver biopsy has been considered to be the "gold standard" to assess fibrosis. However, liver biopsy being invasive and, in many instances, not favored by patients or physicians, alternative approaches to assess liver fibrosis have assumed great importance. Moreover, therapies aimed at reversing the liver fibrosis have also been tried lately with variable results. Till now, there has been no consensus on various clinical, pathological, and radiological aspects of liver fibrosis. The Asian Pacific Association for the Study of the Liver set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The process for the development of these consensus guidelines involved the following: Review of all available published literature by a core group of experts; proposal of consensus statements by the experts; discussion of the contentious issues; and unanimous approval of the consensus statements after discussion. The Oxford System of evidence-based approach was adopted for developing the consensus statements using the level of evidence from 1 (highest) to 5 (lowest) and grade of recommendation from A (strongest) to D (weakest). The consensus statements are presented in this review.

Original languageEnglish
Pages (from-to)323-333
Number of pages11
JournalHepatology International
Issue number2
Publication statusPublished - 2009
Externally publishedYes


  • Cirrhosis
  • HVPG
  • Liver biopsy
  • Noninvasive tools
  • Ultrasound


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