A survey of patterns of practice and perception of NAFLD in a large sample of practicing gastroenterologists in France

作者：Ratziu Vlad^*; Cadranel Jean Francois; Serfaty Lawrence; Denis Jacques; Renou Christophe; Delassalle Patrick; Bernhardt Carole; Perlemuter Gabriel

来源：Journal of Hepatology, 2012, 57(2): 376-383.

• Non-alcoholic steatohepatitis
• Steatosis
• Non-alcoholic fatty liver disease
• Survey
• Fibrosis
• Fibrosis markers
• Therapy
• Gastroenterologists

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.

• 出版日期2012-8