Campbell, E.; Mohammed, I.; Elias, E.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA102
Academic Journal
Background: Non-alcoholic fatty liver disease (NAFLD) encompasses steatosis and steatohepatitis. The prevalence of NAFLD is increasing but it is unclear how clinicians are managing this condition. This study aimed to establish how NAFLD is diagnosed and managed within the UK. Methods: A postal questionnaire was sent to 200 members of the BSG. Number of NAFLD cases per month; parameters are used for diagnosis; indications for biopsy; treatment and follow up were requested. Results: In total 117 questionnaires were returned (58%). 20 were hepatologists (17%), the remainder gastroenterologists. Alcohol (60%) was the commonest reason for outpatient referral, then NAFLD (26%). Hepatologists saw more NAFLD per month than gastroenterologists. Lipids, diabetic status, and body mass index were ranked as helpful in diagnosing NAFLD, but an echobright liver ultrasound was considered more informative. Waist:hip ratio and AST:ALT ratios were rarely used. Hepatologists biopsied significantly more suspected NAFLD than gastroenterologists (p < 0.05). Most gastroenterologists biopsy less than a quarter of suspected NAFLD cases. The strongest indications for biopsy were rising transaminases (53%), with transaminases twice normal the next commonest (29%). Age, AST:ALT ratio, diabetic status, and elevated triglycerides were not seen as indicators for biopsy. Hepatologists review more NAFLD cases yearly in outpatient clinics compared with gastroenterologists (p < 0.05), half of whom never follow up NAFLD cases. All advise weight loss and exercise. No drug therapy was common but statins, metformin, fibrates, and vitamin E were occasionally tried. Conclusion: NAFLD is common but practice varies. Biopsy is not common and therapy infrequent and variable. More evidence is needed before a consensus and guidelines can be formulated.


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