Year 2019 / Volume 111 / Number 4
Original
Analysis of the burden and variability in the management of NAFLD patients in the clinical practice: unifying the required criteria

270-274

DOI: 10.17235/reed.2019.6088/2018

Yolanda Sánchez-Torrijos, Javier Ampuero, Domingo Pérez Palacios, Rocío Gallego-Durán, Manuel Romero-Gómez,

Abstract
Aim: to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in the gastroenterology outpatient clinic and describe the use of the resources accordingly. Methods: a prospective and observational study of 403 patients seen in the gastroenterology outpatient clinic to rule out liver disease during three randomized months in 2016. The overall prevalence of NAFLD, disease severity, heterogeneity of the final diagnosis, the use of medical resources and their respective cost were analyzed. Results: the main reason for consultation was hypertransaminasemia (42.9%, 173/403), followed by hepatitis C virus (HCV) (28.5%, 115/403). NAFLD was identified as the definitive diagnosis in 29.8% (120/403) of the cohort, 69.2% (83/120) derived by hypertransaminasemia and 24.2% (29/120) by steatosis. Laboratory tests were performed in 96.7% (116/120), abdominal ultrasound in 88.3% (106/120), viral serology in 79.2% (95/120) and autoimmunity in 70% (84/120) of patients with NAFLD. Liver fibrosis was not assessed in 87.5% of cases. In a post-hoc analysis, 12.1% (17/120) had advanced fibrosis by FIB-4. On ultrasound, 65% (73/106) had hepatic steatosis and 15% (17/106) chronic liver disease (significant fibrosis). The mean time for diagnosis was 2.23 ± 0.8 visits. The terminology used to define the clinical diagnosis was heterogeneous as follows: a) 48.3% (58/120) hepatic steatosis; b) 15% (18/120) non-alcoholic steatohepatitis; c) 15.8% (19/120) fatty liver; d) 13.3% (16/120) metabolic syndrome; and e) 7.5% (9/120) dual liver disease (fatty liver and alcohol). A pharmacological intervention was performed in six patients, a liver biopsy in two patients and another six were referred to another specialist. The average cost per patient until diagnosis was €570.78, which included analytical, autoantibodies, viral serology and abdominal ultrasound, with a mean of 2.5 consultations. Thus, the total expense in patients with NAFLD was €68,493.6. Conclusion: NAFLD is a frequent cause of hypertransaminasemia. However, the heterogeneity in the management and terminology of the disease makes it necessary to initiate medical training actions in order to unify the criteria for disease control.
Share Button
New comment
Comments
No comments for this article
References
1. Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018 Sep;69(3):718–35.
2. Bellentani S, Scaglioni F, Marino M, et al. Epidemiology of non-alcoholic fatty liver disease. Digestive Diseases. 2010. p. 155–61.
3. Caballería L, Pera G, Arteaga I, et al. High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study. Clin Gastroenterol Hepatol. 2018 Jul;16(7):1138–1145.e5.
4. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23.
5. Bayard M, Holt J, Boroughs E. Nonalcoholic fatty liver disease. Am Fam Physician. 2006 Apr 18;73(11):1961–9.
6. Higuera-de la Tijera F, Servín-Caamaño AI. Pathophysiological mechanisms involved in non-alcoholic steatohepatitis and novel potential therapeutic targets. World J Hepatol. 2015;7(10):1297–301.
7. Ampuero J, Aller R, Gallego-Durán R, Banales JM, et al. The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity. Aliment Pharmacol Ther. 2018 Oct 23;
8. McPherson S, Hardy T, Henderson E, et al. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015 May;62(5):1148–55.
9. Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015 May;61(5):1547–54.
10. Sanchez-Torrijos Y, Ampuero J, Romero-Gómez M. Cardiovascular assessment in liver transplant for non-alcoholic steatohepatitis patients: What we do, what we should do. World J Hepatol. 2017 May 28;9(15):697.
11. Arora A, Sharma P. Non-invasive Diagnosis of Fibrosis in Non-alcoholic Fatty Liver Disease. J Clin Exp Hepatol. 2012 Jun;2(2):145–55.
12. Bhala N, Angulo P, van der Poorten D, et al. The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study. Hepatology. 2011 Oct;54(4):1208–16.
13. Lazo M, Hernaez R, Bonekamp S, et al. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011 Nov 18;343(nov18 2):d6891–d6891.
14. Almpanis Z, Demonakou M, Tiniakos D. Evaluation of liver fibrosis: ?Something old, something new?? Ann Gastroenterol. 2016;29(4):445–53.
15. Samperio-González MA, Selvi-Blasco M, Manzano-Montero M, et al. Prevalencia de la esteatosis hepática no alcohólica en población con hipertransaminasemia y grado de adecuación del diagnóstico registrado en atención primaria. Aten Primaria. 2016;48(5):281–7.
16. Gallego-Durán R, Ampuero J, Funuyet J, et al. Esteatohepatitis alcohólica y no alcohólica: ¿quiénes son los pacientes y qué podemos hacer por ellos? Gastroenterol Hepatol. 2013 Nov;36(9):587–96.
17. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015 Aug;149(2):367–378.e5.
18. Ampuero J, Sánchez-Torrijos Y, Aguilera V, et al. Nuevas perspectivas terapéuticas en la esteatohepatitis no alcohólica. Gastroenterol Hepatol. 2017 Sep 2;40.
19. Byrne CD, Targher G. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia. European Association for the Study of the Liver; 2016;59(6):1141–4.
20. Reccia I, Kumar J, Akladios C, et al. Non-alcoholic fatty liver disease: A sign of systemic disease. Metabolism. 2017 Jul;72:94–108.
Related articles
Citation tools
Sánchez-Torrijos Y, Ampuero J, Pérez Palacios D, Gallego-Durán R, Romero-Gómez M. Analysis of the burden and variability in the management of NAFLD patients in the clinical practice: unifying the required criteria. 6088/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1600 visits.
This article has been downloaded 253 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 02/12/2018

Accepted: 20/01/2019

Online First: 27/02/2019

Published: 04/04/2019

Article revision time: 40 days

Article Online First time: 87 days

Article editing time: 123 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology