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British Liver Trust
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Fibroscan or ELF test for reliability

Sorry for the long post but please bear with me. Has anyone had both of these tests and which one is the most reliable? In February I had a Fibroscan which was very quick and with only 5-6 measures taken. The Hepatologist who did the scan told me at 6.2 Kpa I just had fatty liver and to change my diet and I would be fine. I had another appointment with a different Hepatologist at a local hospital a few weeks later, due to my GP making an error and double booking. This Hepatologist was very dismissive, telling me that as my liver has been fatty for over 10 years it is unlikely to progress to anything worse. She sent me home with a booklet on NAFLD but must have had second thoughts because she then wrote to say she wanted to be on the safe side and would do an ELF test. I didn't hear anything for quite a while but last week she wrote back to say my ELF test showed I had scarring (I found out it was 9.31 which I believe is moderate fibrosis) and she has arranged for me to have an ultrasound scan. Last time I had an ultrasound was 2 years ago which just showed my liver as being fatty. My question is which method is the most reliable? Has anyone else had varying results and which proved to be the most reliable? Thanks in advance.

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Hello I have primary billiary cholangitis I had an ultrasound which showed widespread scarring ,followed by a fibroscan which seemed to show a lot better result not far from normal.I also took part in the trials of the mri multi scan machine this gave results mid way between the other two.As to which is correct I am not sure and it may depend on what is the liver disease but I definitely know there were variable results in my case.Good luck with getting an answer.Jane

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With so many different results it is hard to know which one to go by but I will see what the Hepatologist thinks. Thanks for taking the time to reply.

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What is ELF test? My Dr always offers fibro scan or biopsy... he has never offered me ELF πŸ€”πŸ€”πŸ€”

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Hi BlackMamba,

ELF is an abbreviation of Enhanced Liver Fibrosis test. It is a blood test and I have been told it is supposed to be quite accurate in diagnosing fibrosis and cirrhosis. It is recommended in the NICE guidelines to diagnose fibrosis in people who have fatty liver. Are you in the UK? In my health authority they seem very reluctant to do a biopsy. My Hepatologist insisted there are too many risks involved.

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Thank you for taking time to explain this to me. ELF has never been offered to me. I am in the Uk. I have hep B... maybe ELF is not appropriate for hep B πŸ€”πŸ€”πŸ€”πŸ€”

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Sorry for taking the time to reply to your question, but I've only just seen it while trolling through your previous postings. The ELF test is a fairly new test and is not available under all healthcare trusts, only a few have the facility. I happen to live around the Stoke-on-Trent area and this test was rolled out about 6-months ago. All GP's should be aware of it's availability by now. The ELF test with markers, is a lot more reliable than the basic LFT. The markers, can also be used to identify fatty liver too.

The liver as you'll know, is capable of healing it's self if it's at the fatty liver and even fibrosis stage. However, these causes scaring and this is where the liver becomes fibrosis. If this was to continue then it will lead to cirrhosis and the scaring becomes too damaged. What would concern me is why after 10-years of having fatty liver, has it not fully repaired it's self.

In answer to your question though is that all tests have there uses, but the ELF test a ultrasound should be more reliable. I really think you need to be asking questions as to the cause of your fatty liver. You can't help your liver if you don't know whats causing it to become damaged. Don't be afraid to ask questions, and keep on answering them until your happy with the response and answers. Don't be fobbed off.

Good Luck

Richard

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Thanks for your reply Richard. I think the cause of my fatty liver originally was due to me being slightly overweight and not eating healthily but five years ago I was diagnosed with heart failure and I am on a cocktail of medication which has probably caused the damage or more damage. I also have Chronic Kidney Disease which I know for sure is due to the medication.

My main concern is that the Hepatologist will look at the two results and go by the ultrasound, ignoring the ELF test which I thought might be more reliable. My LFT has been high for quite a while but apart from repeating the tests there has been no action or advise. Today I realised how long I have been waiting to hear back from the Hepatologist so I phoned her secretary and she told be two other Hepatology Consultants have left the hospital and she is doing their work as well as her own so I could be in for a long wait which is causing me to worry.

I did read the NICE guidelines which state that people with NAFLD should be offered an ELF test so I am assuming it has become more widely available now yet I had to fight to get it done.

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Im curious about the 10 years of fatty liver not resolving as well. Usually that would only happen if a persons diwt stayed poor after diagnosis or if a heavy drinker stayed heavy id think

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In my case I hardly ever drink, perhaps one or two small drinks on social occasions no more than once in two months. I think the medication I am on has damaged my liver but I can't be 100% sure and my GP is of no help. My diet is not always perfect but I do try.

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ELF is consodered more reliable as it is less influenced by inflamation and swelling. But keep in mind its also only a snapshot of your current state. The only way to see accuracy in these tests is when they are done multiple times over a period of time. Drs look for patterns and consitencies. So if your fibroscan score or ELF stayed constant over the years than the result is likely very accuate. I myself have had a couple of fibroscans and both times the score was vastly different from the last. As you will find alot of people will say on this site as well.

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The problem is the fibroscan and ultrasound seem to contradict the ELF test. The fibroscan was 6.2Kpa which I believe is in normal range as that is what I was told. I then had the ELF test which was 9.31 (moderate fibrosis) and contradicts the fibroscan. The consultant then decided I should have an ultrasound scan and the technician who carried it out told me there were no changes since the last test 3 years ago which just showed fatty liver and was very similar to the first one I had 5-6 years ago. If that is true then my NALFD has stayed the same over 6 years and is still only at the fatty liver stage but then why would the ELF test come up as fibrosis? That's what doesn't make sense and my concern is they will go by the fibroscan and ultrasound and disregard the ELF test.

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Hi Angedogs

I've had 2 ELF tests and ultrasounds but no fibroscan. The ELF tests were 9.4 and 9.8 and the ultrasound shows a bright liver. So I have been diagnosed with fatty liver. My GP wants to know about the fibrosis issue and says he thinks I need a fibroscan however my consultant said the ELF score was not high and said I wasn't at risk for liver fibrosis and said the ELF can pick up fibrosis elsewhere other than the liver too.

No one other than my GP has suggested any cause as yet, I don't drink and eat healthy but was diagnosed with fibromyalgia in 2011 and more recently with familial high cholesteremia which I suspect will be having an effect in my liver and muscles with inflammation and scarring and could be the main underlying cause.

I am waiting now for another appointment with consultant to see if I can push for a fibroscan just to reassure me on the liver fibrosis.

This has been ongoing for me for a couple of years now, it seems nothing is an immediate concern for any of my doctors and I just keep sticking to a decent diet and as much movement as possible.

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Hi Woodystar

Sorry for the delay in replying but I have only just seen your message. An ELF test of 9.4 or 9.8 is classed as moderate fibrosis. I found a chart with the following information: 7.7 or under is none to mild fibrosis, 7.7 to 9.8 is moderate and above 9.8 is severe. We both fall in the moderate range which I would have thought is enough to cause concern. NICE guidelines state that anyone with an ELF test of 10.51 or over should be diagnosed with advanced fibrosis. Anyone with an ELF test below 10.51 is unlikely to have advanced fibrosis and should be reassessed every 3 years. These are only guidelines and I personally feel 3 years is a long time to have to wait for more tests. I know of people who have gone from fatty liver to cirrhosis in a fairly short period of time. At this stage I don't think there is much in the way of treatment though, other than diet and lifestyle changes but I find it worrying that anyone with moderate fibrosis might be left to worry for that length of time.

Thankfully my Hepatologist finally got in touch with me just before Christmas and explained that going by the ELF test my liver does have scar tissue and the ultrasound confirms chronic changes consistent with fatty build up within the liver and just because definite changes consistent with scarring cannot be seen on the scan it does not mean that it is not there. She has ordered more blood tests and another ultrasound and will see me once she gets the results.

Although I have heard the ELF test is more reliable I hope you manage to get a fibroscan and you find it reassuring. Good luck.

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Thanks Angedogs since I wrote that I've now been put on Statins to address the cholesterol issue and Have a blood test form for loads more blood tests. Also recently had a CT scan for a lung nodule issue. I'm awaiting an appt at a Lipid clinic and still awaiting another gastroenterology appt, even though my GP has written to them requesting a quicker follow up appt. I'm of the opinion that I'm being left and monitored to see what occurs. I will wait to see what these new blood test show and if it's not good then I will push my GP to see someone specific to the liver issue.

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Hi Woodystar

What you say about cholesterol is interesting. I was diagnosed with Familial Hypercholesterolemia quite a few years ago and was put on statins for it but I was having bad side effects and a cardiologist I was seeing at the time decided my arteries were healthy and took me off the statins. Last March a cholesterol test showed my serum cholesterol to be high at 8.7 so I am now on Atorvastatin. There is a definite connection to the liver and I think it's to do with it not being able to eliminate cholesterol properly.

Is your appointment with the Gastroenterologist solely regarding your liver? If so you are better off requesting to see a Hepatologist, even if it means having to travel to see one, as they are more specialised in liver and can deal better with problems and tests. I saw an Gastroenterologist several years ago and they weren't very helpful so this time around I pushed, on the advise of the British Liver Trust, to see a Hepatologist. My GP was reluctant but finally did refer me to the one I am currently seeing.

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Hi angedogs, i have been following your post. I hope you are better now. I have similar issues with my liver. I just wonder what happened following your ELF score of 9.30? I have 9.2 on my recent ELF test.

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Hi Carefull1, Unfortunately there has been no further progress. The Hepatologist ordered another ultrasound and more blood tests which I had at the beginning of January. I finally heard from her this week by letter which explained "the ultrasound scan shows only the chronic changes that we know about in your liver but no new lumps or bumps which should concern us. We will therefore see you in clinic as we had planned." I think she is trying to tell me I haven't got liver cancer but that's not of much help because I am concerned that the fibrosis might have advanced or I could have cirrhosis but there is no mention of that. I haven't even been given an appointment to see her in clinic yet and knowing how busy she is it could be weeks or even months. Did anyone discuss your ELF score with you and are you any the more wiser than I am?

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Hi angedogs. I have an appointment on 14 March for this. I will update you after the appointment

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Okay, thanks and good luck.

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Thanks angedogs, I will update you. I forgot to mention that I also have received an appointment for CT scan in 3 days time. So hopefully the consultant will be in a better position to advise me on 14th March

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Hi carefull1

That's good. I have often wondered what the difference is between an ultrasound and a CT scan. Do you know?

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hi, i heard CT is superior then ultra sound but not sure,

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Your right that it can be IF it's done with contrast. Otherwise it's pretty much on par with an ultrasound.

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Thank you PhoenixPalazzo and carefull1. I have only ever been given an ultrasound scan and just once, years ago, an MRI. Wasn't sure what the difference was between the ultrasound and CT.

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The difference is just in the fact that CT uses xray to produce an image and ultrasound uses shear sound waves to produce an image.

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Thanks for the info.

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Hi. Just to update you. My CT with contrast came normal but ELF blood test score is 9.2. So not sure. Waiting for the appointment with heptologist.

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Hi carefull1, Good luck with your appointment. I am still waiting for my appointment with the Hepatologist. It is now almost a year since I last saw her and had my ELF test so it is most definitely out of date now. I have changed my way of eating so when I do eventually get to see the Hepatologist I may ask for another ELF test. Please let me know how you get on.

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Hi angedogs,

Thank you for sharing your story here, I hope you will get better soon.

I was diagnosed with fatty liver a few years ago while I had a CT for kidney stones. The report pointed out Fatty liver but doctors didn't say anything about it. So I thought it's not something I need to be aware of. Months later (12/2015), I had a gallbladder attack and I was told I need to have my gallbladder removed. I saw a surgeon and he suggested a HIDA scan. HIDA scan came back normal so the surgeon decided not to do the surgery. I was told to reduce fatty foods and multiple portions multiple times a day (6 times or more). Therefore I started eating rice thinking it's healthy. Eventually, rice was dumping more fat into my liver. On November 2016 I started having a dull pain in my right side. I thought it's due to the gallbladder. I went to my primary care provider and he suggested to see a hepatologist. On Jan. 2017 the hepatologist performed a fibroscan and it came back with a 7.5 score. It was shocking to know that I have almost 3rd stage liver damage. I was told I need to the hepatologist once again within one month. Since I don't look like someone who has severe health complication and all my blood test were normal at that time, the hepatologist said don't rely on the fibroscan. She said I don't think you a severe liver issue (if you ever have an issue). She was super rude also because she wanted to have patients with severe liver damage to enroll them in her research study (she also works as a university professor). I've seen another hepatologist in March 2018, he also suggested that my liver is not damaged based on blood tests.

I am so concerned because I cannot convince doctors to seriously consider my situation. The reason why I am concerned because I have been having pain on my right sides under the ribs for almost three years now. Sometimes I feel it under the ribs, sometimes on the right side of the belly, and sometimes on my back. I also Have soreness in my right nipple ( I am a male). All these kind of pains usually get worse when on some days where I have extremely painful urination. I figured that the issue of painful urination is due to the high level of uric acid in my blood and urine. I was given a drug to treat high uric acid 3 weeks ago, and apparently, it caused more damage to my liver because the pain became very bad after taking the drug. I stopped the medicine myself which drove my doctor mad at me. Now I don't know what to do, I feel so helpless. I would love to hear from you about what sort of pain you experience. Here are a few things about myself:

I am 39 YO male, never drink alcohol, not diabetic, no high cholesterol or LDL, triglyceride was 300 a few years ago and I managed to drop it below 150 within a few months. My liver enzymes were high from time to time but after dieting they dropped to normal ranges.

Thank you and sorry for the lengthy message. Please forgive any language mistake as English is not my first language.

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Hi ZTAL223

Thank you too for sharing your story with me.

My Hepatologist doesn't rely on just one test result. She has taken into account an ultrasound scan, which she informs me shows only chronic changes that are already known, high liver enzyme blood tests which are getting progressively higher, one fibroscan which was at 6.2 Kpa (which according to the Hepatologist was of no concern) and the ELF test which was at 9.31 (moderate fibrosis). Some of these results contradict each other so I am still not sure which ones are the most accurate. I think the Hepatologist is supposed to look at all the results and use them to create a picture of what is going on but the trouble is I haven't seen her in almost a year and some of the results are now out of date. She wrote to me a few weeks ago and said she will see me in clinic but this is through the NHS and I know she is very busy due to some other liver doctors leaving and having to do their work as well as hers, so I am not sure when I will get my appointment.

My symptoms have been as follows: an occasional pain behind the right lower ribs, nausea, occasional itching and severe fatigue, but I do have other health conditions so I am not sure which conditions are causing those symptoms. I have had very high uric acid which didn't cause painful urination but I have read it can be painful if stones are formed. I was told the high uric acid, for me, was due to some of the medication I was on which caused gouty arthritis (my joint pain is not like gout pain) and I have been put on Allopurinal which I am sure, along with some other medication has cause my kidney function to deteriorate.

I am not sure what to suggest other than go back to your doctor and ask for more tests and a second opinion from a different Hepatologist especially as the one you saw last time should not have brushed you aside without doing more tests.

I will let you know how I get on once I get my appointment to see my Hepatologist. Hopefully I won't have to wait much longer.

Good luck.

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angedogs,

Thank you for getting back to me. I just scheduled an appointment with a new GI for this Friday. I hope I will come up with some useful outcomes.

I cannot figure out why I am having burning urine as I tested negative to all possible causes (infections, prostate, cancer, or stones). So I assumed it's due to increased acidity in my urine. I took the Allopurinal also, which causes terrible pain in my kidneys and liver area, plus it increases my liver enzymes quickly. I quit the drug and plan to see my urologist tomorrow to see what else we can do for uric acid. I am currently under strict dieting to lose weight (204 lbs right now, was 240 lbs) and to reduce the acidity in my body. It's not helping that much though. I read that a damaged liver could get worse with high serum uric acid.

The pain I am having usually on my front right side, just right under the ribs. Sometimes under the ribs from the back side.

I am glad that I found your post so we can share the experience.

Thank you!

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