Screening for Nonalcoholic Fatty Liver Disease in the Primary Care Clinic

Vijay Pandyarajan, Robert G Gish, Naim Alkhouri, Mazen Noureddin, Vijay Pandyarajan, Robert G Gish, Naim Alkhouri, Mazen Noureddin

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a spectrum of diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) to advanced fibrosis and cirrhosis as well as liver cancer. Despite the significant morbidity associated with NAFLD, there are no global consensus guidelines to screen for liver fibrosis in patients considered high risk, including patients older than 50 years with type 2 diabetes or metabolic syndrome. Multiple therapies are currently being investigated and may soon receive regulatory approval for use in the clinic. It is suggested that patients at high risk for NAFLD be screened in the outpatient setting. This article aims to supply primary care providers (PCPs) with the knowledge and tools needed to properly evaluate a patient at high risk of developing significant liver disease from NASH. A tripartite algorithm is described to help PCPs identify patients with NAFLD using liver enzymes and abdominal ultrasound, assess the presence of advanced liver fibrosis using clinical prediction rules, and, if appropriate, determine when to refer patients to specialist care.

Keywords: Nonalcoholic fatty liver disease; ambulatory care; fatty liver; nonalcoholic steatohepatitis; outpatients; primary care; screening.

Conflict of interest statement

Dr Alkhouri has received research funding from Gilead, Intercept, Genfit, and Allergan, and is a member of the speakers bureaus and advisory boards of Gilead and Intercept. Dr Noureddin has been on the advisory boards and/or has been a speaker for Echosens North America, OWL, Gilead, Intercept, Simply Speaking, Novartis, Blade, Allergan, and Abbott; has received research support from Gilead, Galmed, Galectin, Conatus, Enanta, Zydus, Novartis, BMS, Allergan, Genfit, and Shire; and is a minor shareholder of Anaetos and Viking. Dr Gish is a direct consultant for Viking and Intercept. Dr Pandyarajan has no relevant conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Suggested screening and treatment algorithm for NAFLD. ALT, alanine aminotransferase; FIB-4, Fibrosis-4; NAFLD, nonalcoholic fatty liver disease; NFS, NAFLD Fibrosis Score.
Figure 2.
Figure 2.
Suggested treatment for patients with different forms of fatty liver disease. HCC, hepatocellular carcinoma; NAFL, nonalcoholic fatty liver; NASH, nonalcoholic steatohepatitis.

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Source: PubMed

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