• liver biopsy
• liver function
• fatty liver disease

Roger Chapman (Gut 2002;51:9–10) commenting on the recent important study from Nottingham¹ concluded that there is a strong case for liver biopsy in most asymptomatic patients with persistently abnormal liver tests, even when diagnostic serology is negative. This conclusion is reasonable, particularly if diagnostic accuracy is paramount. However, accuracy is not the only consideration and other equally valid conclusions can be made from different viewpoints.

Unfortunately, liver biopsy is often painful,² requires bed rest for at least six hours,³ and is associated with a small but definite mortality.⁴ We need to appraise our patients of these factors and the likely benefits so that they can make an informed choice. Standard methods of evidence based medicine can greatly assist us in doing this.

As the predominant finding on biopsy is non-alcoholic fatty liver disease (NAFLD), the first question is: can any other test reliably predict fatty liver in this situation? There are three imaging techniques which can detect fatty liver—ultrasound, computerised tomography, and magnetic …