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Review
. 2020 Dec 5;3(2):100219.
doi: 10.1016/j.jhepr.2020.100219. eCollection 2021 Apr.

Case-finding strategies in non-alcoholic fatty liver disease

Jerome Boursier  1   2 , Emmanuel A Tsochatzis  3   4
Affiliations
Review

Case-finding strategies in non-alcoholic fatty liver disease

Jerome Boursier et al. JHEP Rep. .

Abstract

Among the large population of patients with non-alcoholic fatty liver disease (NAFLD), identifying those with advanced disease remains challenging. Many patients are diagnosed late, following the development of liver-related complications, leading to poor clinical outcomes. Accumulating evidence suggests that using non-invasive tests for liver fibrosis in patients with metabolic risk factors improves the detection of patients in need of specialised management and is cost-effective. Because of the vast number of patients requiring evaluation, the active participation of general practitioners and physicians who manage patients with metabolic disorders, such as diabetologists, is crucial; this calls for the increased awareness of NAFLD beyond liver clinics. Non-invasive case-finding strategies will need to be further validated and generalised for upcoming drug therapies to have the required impact on the worldwide burden of NAFLD.

Keywords: ALD, alcohol-related liver disease; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Awareness; Case-finding; Cirrhosis; Cost-effectiveness; ELF, enhanced liver fibrosis; Elastography; FIB-4; FIB-4, fibrosis-4; GP, general practitioner; Liver fibrosis; NAFLD, non-alcoholic fatty liver disease; NAS, NAFLD activity score; NASH, non-alcoholic steatohepatitis; NFS, NAFLD fibrosis score; NICE, National Institute of Clinical Excellence; NIT, non-invasive test; Patient pathway; Primary care; QALY, quality-adjusted life year; Screening; T2DM, type 2 diabetes mellitus; TE, transient elastography; Type 2 diabetes mellitus.

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Conflict of interest statement

J Boursier has consulting activities and received support for research from Echosens and Siemens. E Tsochatzis has no relevant conflicts of interest to declare. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Fig. 1
Fig. 1
Populations at risk of NAFLD-related liver outcomes. NAFLD, non-alcoholic fatty liver disease.
Fig. 2
Fig. 2
Non-invasive tests for liver fibrosis. MRE, magnetic resonance elastography; SWE, shearwave elastography; VCTE, vibration controlled transient elastography.
Fig. 3
Fig. 3
Testing pathway for patients with a diagnosis of NAFLD in non-hepatology specialties. An initial FIB-4 is followed by elastography or a patented serum non-invasive test such as ELF or FibroMeter. The target lesion is the presence of advanced fibrosis. NIT, non-invasive test.
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