Non-alcoholic fatty liver disease screening: Difference between revisions

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==Overview==
==Overview==
There is insufficient evidence to recommend routine screening for NAFLD.But it can be argued that at least for high-risk profiles like [[obesity]], [[insulin resistance]] and patients with [[metabolic syndrome]] should be screened for NAFLD. However, at present, there are significant gaps in our knowledge regarding the diagnosis, natural history, and treatment of NAFLD.Sometimes patients with normal liver enzyme levels have NAFLD and NASH and maybe not enough for screening alone but with ultrasound which is sensitive can serve as a screening test.
There is insufficient evidence to recommend routine screening for NAFLD in general population. However, screening is recommended in high-risk population groups([[obesity]], [[insulin resistance]] and patients with [[metabolic syndrome]]) as more than 50 million Americans have been estimated to have metabolic syndrome and about 80% of them have NAFD.


==Screening==
==Screening==
* There is insufficient evidence to recommend routine screening for NAFLD.
* There is insufficient evidence to recommend routine screening for NAFLD in general population.<ref name="pmid28544608">{{cite journal| author=Koot BGP, Nobili V| title=Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance? | journal=Obes Rev | year= 2017 | volume= 18 | issue= 9 | pages= 1050-1060 | pmid=28544608 | doi=10.1111/obr.12556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28544608  }} </ref><ref name="pmid28213828">{{cite journal| author=Kummer S, Klee D, Kircheis G, Friedt M, Schaper J, Häussinger D et al.| title=Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis. | journal=Eur J Pediatr | year= 2017 | volume= 176 | issue= 4 | pages= 529-536 | pmid=28213828 | doi=10.1007/s00431-017-2876-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28213828  }} </ref><ref name="pmid27605111">{{cite journal| author=Glen J, Floros L, Day C, Pryke R, Guideline Development Group| title=Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance. | journal=BMJ | year= 2016 | volume= 354 | issue=  | pages= i4428 | pmid=27605111 | doi=10.1136/bmj.i4428 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27605111  }} </ref>
* Most of the time NAFLD is accidental finding on routine ultrasound.
* However, American Gastroenterological Association Technical Review  recommends screening for non-alcoholic fatty liver disease in population at high risk such as [[obesity]], [[insulin resistance]], and [[metabolic syndrome]].
* NAFLD usually has no symptoms. So diagnosing the problem often starts after a blood test finds higher-than-normal levels of liver enzymes. A standard blood test could reveal these results.
* Screening is however complicated by the lack of accurate, noninvasive diagnostic tools for NAFLD and the lack of clear treatment that can be proposed to the patient.


However, the AGA recommend screening<ref name="pmid37542503">{{cite journal| author=Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ| title=AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. | journal=Gastroenterology | year= 2023 | volume=  | issue=  | pages=  | pmid=37542503 | doi=10.1053/j.gastro.2023.06.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37542503  }} </ref>.


{{Family tree/start}}
Workflows to promote screening may increase treatment<ref name="pmid37549979">{{cite journal| author=Zhang X, Yip TC, Wong GL, Leow WX, Liang LY, Lim LL | display-authors=etal| title=Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial. | journal=Gut | year= 2023 | volume=  | issue=  | pages=  | pmid=37549979 | doi=10.1136/gutjnl-2023-330269 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37549979 }} </ref>.
{{Family tree ||| | A01 | | | |A01= Incidental finding of Fatty liver on ultrasound}}
{{Family tree | | | | |!| | | | | }}
{{Family tree ||| | A01 | | | |A01= Check for persistently raised LFTs}}
{{Family tree | | | | |!| | | | | }}
{{Family tree || | | B01 | | | |B01= Ask the patient for significant alcohol intake}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02| |C01= NO| C02= YES}}
{{familytree | |!| | | | | |!| | | | | | | | | | }}
{{Family tree | D01 | | | | D02 |D01= Diagnose NAFLD| D02= Consider other<br> alcoholic related diseases}}
{{Family tree/end}}


 
== Screening modalities ==
'''Monitor severity of the disease'''
* Serum tests of liver function
 
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= Offer Enhanced Liver Fibrosis Test (ELF)}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | C01 | | | | C02 |C01= (>10.51)  ELF  Positive| C02= (<10.51) ELF Negative}}
{{Family tree | | | |!| | | | | |!| | }}
{{Family tree | | | D01 | | | | D02 |D01= Indicating advanced fibrosis and risk of progression to cirrhosis| D02= Typically Benign -- Advanced fibrosis unlikely}}
{{Family tree | | | |!| | | | | | | | }}
{{Family tree | | | E01 | | | | |E01= Refer the patient to Heptologist}}
{{Family tree/end}}
 
* On negative ELF test offer retest for every 3 years for adults and 2 years for children.


==References==
==References==

Latest revision as of 01:49, 25 August 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

There is insufficient evidence to recommend routine screening for NAFLD in general population. However, screening is recommended in high-risk population groups(obesity, insulin resistance and patients with metabolic syndrome) as more than 50 million Americans have been estimated to have metabolic syndrome and about 80% of them have NAFD.

Screening

  • There is insufficient evidence to recommend routine screening for NAFLD in general population.[1][2][3]
  • However, American Gastroenterological Association Technical Review recommends screening for non-alcoholic fatty liver disease in population at high risk such as obesity, insulin resistance, and metabolic syndrome.
  • Screening is however complicated by the lack of accurate, noninvasive diagnostic tools for NAFLD and the lack of clear treatment that can be proposed to the patient.

However, the AGA recommend screening[4].

Workflows to promote screening may increase treatment[5].

Screening modalities

  • Serum tests of liver function

References

  1. Koot BGP, Nobili V (2017). "Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance?". Obes Rev. 18 (9): 1050–1060. doi:10.1111/obr.12556. PMID 28544608.
  2. Kummer S, Klee D, Kircheis G, Friedt M, Schaper J, Häussinger D; et al. (2017). "Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis". Eur J Pediatr. 176 (4): 529–536. doi:10.1007/s00431-017-2876-1. PMID 28213828.
  3. Glen J, Floros L, Day C, Pryke R, Guideline Development Group (2016). "Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance". BMJ. 354: i4428. doi:10.1136/bmj.i4428. PMID 27605111.
  4. Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ (2023). "AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review". Gastroenterology. doi:10.1053/j.gastro.2023.06.013. PMID 37542503 Check |pmid= value (help).
  5. Zhang X, Yip TC, Wong GL, Leow WX, Liang LY, Lim LL; et al. (2023). "Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial". Gut. doi:10.1136/gutjnl-2023-330269. PMID 37549979 Check |pmid= value (help).

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