期刊
GASTROENTEROLOGY
卷 161, 期 5, 页码 1657-1669出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2021.07.049
关键词
Nonalcoholic Fatty Liver Disease; NAFLD; Nonalcoholic Steatohepatitis; NASH; Liver Disease; Clinical Care Pathway
资金
- American Gastroenterological Association
- Intercept Pharmaceuticals, Inc
- Pfizer Inc
- Allergan
- GENFIT
- American Association of Clinical Endocrinologists
- American Academy of Family Physicians
- American Association for the Study of Liver Diseases
- American College of Osteopathic Family Physicians
- American Diabetes Association
- Endocrine Society
- The Obesity Society
- Veterans Administration Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas [CIN 13-413]
- National Cancer Institute [NCI U01 CA230997]
- Cancer Prevention and Research Institute of Texas grant [RP150587]
- National Institute of Health Nonalcoholic Steatohepatitis Clinical Research Network [DK061713-19]
- National Institute of Environmental Health Science [5P42ES010337]
- National Center for Advancing Translational Sciences [5UL1TR001442]
- Department of Defense Peer Reviewed Cancer Research Program [W81XWH-18-2-0026]
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK061734, R01DK106419, R01DK121378, R01DK124318, P30DK120515]
- National Heart, Lung, and Blood Institute [P01HL147835]
- National Institute on Alcohol Abuse and Alcoholism [U01AA029019]
NAFLD is a common disease that affects a significant proportion of US adults. Management typically occurs in primary care or endocrine clinics, where accurate staging for fibrosis risk through screening is crucial, requiring consistent, timely, evidence-based, and easily testable management processes.
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.
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