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While several indices with combinations of liver associated markers such as FIB4 seem to be promising, non-invasive test strategies are urgently needed with cut-off\u2019s that can be applied to guide clinical decision making. The aims of this review article are to highlight novel developments for the diagnosis of ALD and to identify topics of controversy and potential future directions. In the last 15 years, elastography to measure liver stiffness (LS) has significantly improved our screening strategies for cirrhosis. LS values below 6 kPa are considered as normal and exclude ALD. LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. Especially, transient elastography (TE) has been assessed in numerous studies, but similar performance can be obtained with point shear wave elastography, 2 SD shear wave elastography or MR elastography. Important confounders of elevated LS such as inflammation should also be considered and alcohol withdrawal not only improves liver inflammation but also LS. Liver stiffness measurement has signficiantly improved early diagnosis and follow-up of fibrosis in patients with ALD and patients with diagnosed manifest but clinically compensated cirrhosis should undergo further clinical examinations to rule out complications of portal hypertension. In addition, surveillance for the occurrence of hepatocellular carcinoma is recommended in all cirrhotic patients.<\/jats:p>","DOI":"10.1055\/a-1713-4372","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T18:38:34Z","timestamp":1642531114000},"page":"45-57","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic challenges in patients with alcohol-related liver disease"],"prefix":"10.1055","volume":"60","author":[{"given":"Aleksander","family":"Krag","sequence":"additional","affiliation":[{"name":"Centre for Liver Research\/Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark"},{"name":"Institute of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Roskams","sequence":"additional","affiliation":[{"name":"Department of Imaging and Pathology, University of Leuven, Leuven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Pinzani","sequence":"additional","affiliation":[{"name":"University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Mueller","sequence":"additional","affiliation":[{"name":"Centre of Alcohol Research, University of Heidelberg, Heidelberg, Germany"},{"name":"Department of Medicine, Salem KH, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,1,18]]},"reference":[{"issue":"03","key":"ref2","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1053\/j.gastro.2014.11.039","article-title":"Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United 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