Abstract Background and Aim Considering the increasing prevalence of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis (NASH), the development of an effective screening and follow‐up system that enables the recognition of etiological changes by primary physicians in clinics and specialists in hospitals is required. Methods Chronic hepatitis B (HBV) and C (HCV), NASH, and alcoholic steatohepatitis (ASH) patients who were assayed for Mac‐2‐binding protein glycosylation isomer (M2BPGi) (n = 272) and underwent magnetic resonance elastography (MRE) (n = 119) were enrolled. Patients who underwent MRE were also tested by ultrasound elastography (USE) (n = 80) and for M2BPGi (n = 97), autotaxin (ATX) (n = 62), and platelet count (n = 119), and their fibrosis‐4 (FIB‐4) index was calculated (n = 119). Results FIB‐4 index >2, excluding HBV‐infected patients, M2BPGi >0.5, ATX >0.5, and platelet count F3 or F4; it could efficiently predict collateral circulation with high sensitivity, which can replace USE. We also identified etiological features and found that collateral circulation in NASH/ASH patients tended to exceed high‐risk levels; moreover, these patients exhibited more variation in HCC‐associated liver stiffness than the HBV and HCV patients. Conclusions Using appropriate markers and tools, we can establish a stepwise, practical, noninvasive, and etiology‐based screening and follow‐up system in primary and specialty care.
