How should we manage patients with non-alcoholic fatty liver disease in 2007?
| Autor: | H. Janaka de Silva, Nancy W-Y Leung, Geoffrey C. Farrell, Henry Ly Chan, Seng Gee Lim |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Diagnostic Imaging
medicine.medical_specialty Asia Diet therapy Biopsy Bariatric Surgery Motor Activity Pacific Islands Severity of Illness Index Liver disease Liver Function Tests Risk Factors medicine Humans Obesity Intensive care medicine Life Style Hypolipidemic Agents Metabolic Syndrome Hepatology medicine.diagnostic_test business.industry Fatty liver Gastroenterology medicine.disease Diet Surgery Fatty Liver Liver biopsy Practice Guidelines as Topic Liver function Steatohepatitis Metabolic syndrome Liver function tests business |
| Zdroj: | Journal of Gastroenterology and Hepatology. 22:801-808 |
| ISSN: | 1440-1746 0815-9319 |
| DOI: | 10.1111/j.1440-1746.2007.04977.x |
| Popis: | Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia-Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia-Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of other liver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liver disease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management. |
| Databáze: | OpenAIRE |
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