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

被引:398
作者
Kanwal, Fasiha [1 ,2 ]
Shubrook, Jay H. [3 ]
Adams, Leon A. [4 ]
Pfotenhauer, Kim [5 ]
Wong, Vincent Wai-Sun [6 ]
Wright, Eugene [7 ]
Abdelmalek, Manal F. [7 ]
Harrison, Stephen A. [8 ]
Loomba, Rohit [9 ]
Mantzoros, Christos S. [10 ]
Bugianesi, Elisabetta [11 ]
Eckel, Robert H. [12 ]
Kaplan, Lee M. [10 ,13 ]
El-Serag, Hashem B. [1 ,2 ]
Cusi, Kenneth [14 ,15 ]
机构
[1] Baylor Coll Med, Dept Med, Sect Gastroenterol & Hepatol, Houston, TX 77030 USA
[2] Michael E DeBakey VA Med Ctr, Vet Affairs Hlth Serv Res & Dev, Ctr Innovat Qual Effectiveness & Safety, Houston, TX USA
[3] Touro Univ Calif, Coll Osteopath Med, Vallejo, CA USA
[4] Univ Western Australia, Med Sch, Perth, WA, Australia
[5] Michigan State Univ, Coll Osteopath Med, E Lansing, MI 48824 USA
[6] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China
[7] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA
[8] Univ Oxford, Radcliffe Dept Med, Oxford, England
[9] Univ Calif San Diego, Dept Med, NAFLD Res Ctr, La Jolla, CA 92093 USA
[10] Harvard Med Sch, Boston, MA 02115 USA
[11] Univ Torino, Dept Med Sci, Turin, Italy
[12] Univ Colorado, Anschutz Med Campus, Aurora, CO USA
[13] Massachusetts Gen Hosp, Gastroenterol Div, Boston, MA 02114 USA
[14] Univ Florida, Gainesville, FL 32610 USA
[15] Malcom Randall Vet Affairs Med Ctr, Gainesville, FL USA
关键词
Nonalcoholic Fatty Liver Disease; NAFLD; Nonalcoholic Steatohepatitis; NASH; Liver Disease; Clinical Care Pathway; PLACEBO-CONTROLLED TRIAL; TRANSIENT ELASTOGRAPHY; AMERICAN ASSOCIATION; DIAGNOSTIC-ACCURACY; INSULIN SENSITIVITY; ADVANCED FIBROSIS; PRACTICE GUIDANCE; UNITED-STATES; ADD-ON; PIOGLITAZONE;
D O I
10.1053/j.gastro.2021.07.049
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:1657 / 1669
页数:13
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