LIVER: Edited by Don C. RockeyHepatic manifestations of cystic fibrosisDana, Jeremya; Girard, Murielb,c; Debray, Dominiqueb,dAuthor Information aDepartment of Pediatric Radiology, APHP-Necker Hospital bPediatric Hepatology Unit, Reference center for Biliary Atresia and Cholestatic Genetic Diseases, APHP-Hôpital Necker cLaboratory of Nutrient Sensing Mechanisms, Inserm U1151, Institut Necker Enfants Malades (INEM), Université de Paris dSorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France Correspondence to Dominique Debray, MD, PhD, Pediatric Hepatology Unit, Hôpital Necker-Enfants Malades, 149 rue de SEVRES, Paris 75015, France. Tel: +33 1 44 49 25 88; fax: +33 1 44 49 25 01; e-mail: firstname.lastname@example.org Current Opinion in Gastroenterology: May 2020 - Volume 36 - Issue 3 - p 192-198 doi: 10.1097/MOG.0000000000000624 Buy Metrics Abstract Purpose of review Liver disease in cystic fibrosis (CF) usually develops before puberty, is often asymptomatic and slowly progressive. Multilobular cirrhosis develops in approximately 5–10% of patients by the age of 18, and is a significant contributor to the morbidity and mortality. No therapy, including ursodeoxycholic acid and cystic fibrosis transmembrane conductance regulator correctors or potentiators, has proven effective to prevent or halt the progression of liver disease towards cirrhosis and portal hypertension. This review provides the current knowledge in the epidemiology of CF liver disease and development of noninvasive tools to assess liver disease severity and progression overtime in order to optimize clinical management and therapeutic options. Recent findings Liver disease not only develops during childhood but also later in the lifetime of patients with CF; the incidence of cirrhosis with portal hypertension increases progressively reaching 10% by age 30. Several noninvasive tools to measure liver stiffness as an indirect measure of fibrosis are being investigated, and show promising results for the assessment of early stages of liver fibrosis and disease progression. Summary Identifying noninvasive biomarkers is fundamental to improving early diagnosis, monitoring disease evolution and measuring treatment effects. A prerequisite is the use of consistent definitions for CF- liver disease (LD) in clinical trials. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.