Liver Fibrosis Leader
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Cogent Family Healthcare
Stephen J Sims, MD
Family Medicine located in Mountain View, CA
Liver fibrosis caused by excess fats accumulating in liver cells, even without any alcohol is a serious disease often causing heart attacks, liver cancer and cirrhosis which can require a liver transplant. Fatty liver (steatosis), which can lead to liver fibrosis is present but un-diagnosed in 80 to 100 million Americans including 70% of those with diabetes, 35% of South Asians and 25% of the world‘s population, more often with prediabetes, alcohol use, obesity, high blood pressure and heart disease. It is very important that you find out whether you might have fatty liver or liver fibrosis by entering your standard blood tests in a calculator (see below) and need to have the definitive Fibroscan liver ultrasound recommended in guidelines, provided in Dr. Sims' office.
Liver Fibrosis Testing
Find out whether you have fatty liver or liver fibrosis using the most highly recommended test - the Fibroscan liver ultrasound. FibroScan® is widely recognized as the clinical benchmark for non-invasive liver assessment (see the liver fibrosis page). AASLD and AACE guidelines support the use of FibroScan® in primary care settings to assess liver fibrosis in at-risk patients. We are one of the first primary care offices in Northern California to provide in-office Fibroscan for your convenience.
If your FIB-4 score is over 1.0 Dr. Sims recommends a Fibroscan*. Check your FIB-4 score here https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis.
* The 2025 American Diabetes Association guideline on screening for liver fibrosis recommends most highly the FIB-4 plus Fibroscan sequence that we use. We use a FIB-4 cutoff of 1.0 because the 1.3 cutoff only reliably detects advanced fibrosis but early fibrosis is the FDA-approved threshold for treating liver fibrosis using the same medications. We have detected several patients with early or even advanced liver fibrosis with a FIB-4 score under 1.3 and in patients over 65 years old with a FIB-4 score far below 2.0. I do not want my patients falsely reassured, leaving their disease to progress undetected by using the 1.3 FIB-4 cutoff (2.0 for 65+ years old) instead of the more sensitive 1.0 FIB-4 cutoff. The confirmatory Fibroscan is inexpensive (covered by insurance at a cost of $140 from Medicare and usually covered at $140 to $300 for commercial insurance) non-invasive and convenient in our office, so the more sensitive screening test using a FIB-4 cutoff of 1.0 is more appropriate medically.
