Gastroenterology: Preparing for the NASH Epidemic: A Call to Action

Abstract: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common conditions with a rising burden. Yet there are significant management gaps between clinical guidelines and practice in patients with NAFLD and NASH. Further, there is no single global guiding strategy for the management of NAFLD and NASH. The American Gastroenterological Association, in collaboration with 7 professional associations, convened an international conference comprising 32 experts in gastroenterology, hepatology, endocrinology, and primary care from the United States, Europe, Asia, and Australia. Conference content was informed by the results of a national NASH Needs Assessment Survey. The participants reviewed and discussed published literature on global burden, screening, risk stratification, diagnosis, and management of individuals with NAFLD, including those with NASH. Participants identified promising approaches for clinical practice and prepared a comprehensive, unified strategy for primary care providers and relevant specialists encompassing the full spectrum of NAFLD/NASH care. They also identified specific high-yield targets for clinical research and called for a unified, international public health response to NAFLD and NASH.

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

Abstract: Nonalcoholic  fatty liver  disease  (NAFLD) is  becoming increasingly  common, currently  affecting  approximately37% 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 avail-able 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.

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Review 2020 survey data from 751 physicians on education and tools needed to combat the NAFLD/NASH epidemic.

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