Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

Fasiha Kanwal, Jay H Shubrook, Leon A Adams, Kim Pfotenhauer, Vincent Wai-Sun Wong, Eugene Wright, Manal F Abdelmalek, Stephen A Harrison, Rohit Loomba, Christos S Mantzoros, Elisabetta Bugianesi, Robert H Eckel, Lee M Kaplan, Hashem B El-Serag, Kenneth Cusi, Fasiha Kanwal, Jay H Shubrook, Leon A Adams, Kim Pfotenhauer, Vincent Wai-Sun Wong, Eugene Wright, Manal F Abdelmalek, Stephen A Harrison, Rohit Loomba, Christos S Mantzoros, Elisabetta Bugianesi, Robert H Eckel, Lee M Kaplan, Hashem B El-Serag, Kenneth Cusi

Abstract

Find AGA's NASH Clinical Care Pathway App for iOS and Android mobile devices at nash.gastro.org. Scan this QR code to be taken directly to the website.Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common, currently affecting approximately 37% of US adults. NAFLD is most often managed in primary care or endocrine clinics, where clinicians must determine which patients might benefit from secondary care to address hepatic manifestations, comorbid metabolic traits, and cardiovascular risks of the disease. Because NAFLD is largely asymptomatic, and because optimal timing of treatment depends on accurate staging of fibrosis risk, screening at the primary care level is critical, together with consistent, timely, evidence-based, widely accessible, and testable management processes. To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2-F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices.

Keywords: Clinical Care Pathway; Liver Disease; NAFLD; NASH; Nonalcoholic Fatty Liver Disease; Nonalcoholic Steatohepatitis.

Copyright © 2021. Published by Elsevier Inc.

Figures

Figure 1.
Figure 1.
Screening for advanced fibrosis related to NAFLD/NASH.
Figure 2.
Figure 2.
Evaluate for other forms of liver disease.
Figure 3.
Figure 3.
Management of NAFLD/NASH.

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