A survey of patterns of practice and perception of NAFLD in a large sample of practicing gastroenterologists in France
| Autor: | Vlad Ratziu, Jean-François Cadranel, Gabriel Perlemuter, Christophe Renou, Lawrence Serfaty, Jacques Denis, Carole Bernhardt, Patrick Delassalle |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Biopsy MEDLINE Disease Gastroenterology Non-alcoholic Fatty Liver Disease Internal medicine Health care medicine Humans Practice Patterns Physicians' Intensive care medicine Grading (tumors) Hepatology medicine.diagnostic_test business.industry Fatty liver Alanine Transaminase Middle Aged medicine.disease digestive system diseases Fatty Liver Liver Liver biopsy Female France Steatohepatitis business |
| Zdroj: | Journal of Hepatology. 57:376-383 |
| ISSN: | 0168-8278 |
| DOI: | 10.1016/j.jhep.2012.03.019 |
| Popis: | Background & Aims Most studies on non-alcoholic fatty liver disease (NAFLD) originate from tertiary care centers with an academic interest. How this emerging entity is accepted and managed by a wider body of gastroenterologists is unknown, despite significant implications for the diagnosis of at-risk subjects and the utilization of healthcare resources. Methods We conducted a survey among 352 French, board-certified gastroenterologists from a large variety of practices to understand the clinical burden, perceived severity, and management patterns of NAFLD. Results Half of participants saw >30 new cases (equal to HCV) of NAFLD and 40% >5 new cases of NASH-cirrhosis yearly. Only 20% of patients were referred by endocrinologists; conversely, gastroenterologists overwhelmingly referred NAFLD patients for assessment of metabolic co-morbidities. In patients with metabolic risk factors, a majority of physicians considered the diagnosis of NAFLD, even if other liver diseases co-existed. The diagnosis heavily relies on aminotransferases, hence patients with normal ALT are usually not diagnosed. Liver biopsy is performed for fibrosis staging but not for the diagnosis/grading of steatohepatitis, and mainly decided based on non-invasive fibrosis procedures. Pharmacological treatment is used despite a lack of clear evidence of efficacy. Physicians monitor patients themselves, usually twice a year. Conclusions NAFLD is recognized and accepted as a disease in itself with potentially severe outcomes. Most at-risk patients are currently missed because of non-referral by endocrinologists and no exploration of those with normal aminotransferases. The medical need for the diagnosis and treatment of NAFLD is real in the community of gastroenterologists at large. |
| Databáze: | OpenAIRE |
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