Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them.

Autor:	Marciano S; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: sebastian.marciano@hospitalitaliano.org.ar., Dirchwolf M; Sección Hepatología, Hospital Privado de Rosario, Rosario, Argentina., Torres MC; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Allevato J; Unidad de Diagnóstico y Tratamiento para Enfermedades Hepáticas de Neuquén, Neuquén, Argentina., García Dans C; Sección Hepatología, Hospital Zonal Bariloche Dr. Ramón Carrillo, Bariloche, Argentina., García B; Sección Hepatología, Centro de Estudios Digestivos de Mendoza, Mendoza, Argentina., Pollarsky F; Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Gaite L; Sección Hepatología, Clínica de Nefrología, Santa Fe, Argentina., Sirotinsky E; Centro de Estudios Digestivos, Comodoro Rivadavia, Argentina., Rios B; Hepatología, Centro de Investigación, Neuquén, Argentina., Anselmo MN; Sección Gastroenterología y Hepatología, Hospital Zonal Esquel, Esquel, Argentina., Peche M; Hospital López Lima Gral Roca, Rio Negro, Argentina., Hurtado E; Hospital Municipal Coronel Suárez, Buenos Aires, Argentina., Haddad L; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Narvaez A; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Mauro E; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Martinez A; Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina., Bellizzi C; Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina., Ratusnu N; Hospital Regional de Ushuaia, Ushuaia, Tierra del Fuego, Argentina., D Amico C; Hepatología, CEMA - Centro de Especialidades Médicas Ambulatoria, Mar del Plata, Argentina., Arora S; Project ECHO, School of Medicine, University of New Mexico, Albuquerque, New Mexico, Estados Unidos de América., Gadano A; Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Jazyk:	English; Spanish; Castilian
Zdroj:	Revista de gastroenterologia de Mexico (English) [Rev Gastroenterol Mex (Engl Ed)] 2021 Mar 24. Date of Electronic Publication: 2021 Mar 24.
DOI:	10.1016/j.rgmx.2020.08.006
Abstrakt:	Introduction and Aims: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. Materials and Methods: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. Results: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. Conclusions: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations. (Copyright © 2021 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)
Databáze:	MEDLINE
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