Diagnosis, treatment of non-alcoholic fatty liver disease (NAFLD)
Diagnosis and treatment of NAFLD isn’t always precise, but new developments are helping to pave the way for better management of the disease, shares a panel of experts.
Speaking on the options for noninvasive diagnosis of NAFLD, Dr. Yusuf Yilmaz, of the department of gastroenterology, Marmara University, Istanbul, Turkey, said diagnosis of steatosis can be performed using ultrasonography but only for those with more than 30 percent steatosis. As for the use of biomarkers in the prediction of non-alcoholic steatohepatitis (NASH), Yusuf said the CK18 fragment is still the only biomarker which has been extensively validated. However, he cautioned that the test is far from perfect and yet to make its way into widespread clinical practice.
With regards to fibrosis prediction, the only model adequately validated for clinical use is the NAFLD Fibrosis Score. At the end of the day, Yusuf noted that noninvasive tests are currently insufficient to replace biopsy. However, liver biopsy is avoidable in a large number of cases. Elastography can be used to predict advanced fibrosis and to help in the decision to perform liver biopsy.
All NAFLD patients to receive lifestyle advice
Weight reduction via lifestyle modification and improvement should be dictated to all patients with NAFLD, said Dr. Elisabetta Bugianesi.
Bugianesi, associate professor of gastroenterology, University of Turin, Italy, said this was because weight reduction through lifestyle modification with diet and exercise leads to improvement of cardiovascular risk profile, improvement of steatosis and probable reduction in inflammation (of the liver). In general, NAFLD patients lack confidence to exercise and have scarce readiness to embrace lifestyle changes. Bugianesi recommended that these patients be afforded behavioural counselling in order to help them overcome their reluctance.
Beyond lifestyle modifications, typical treatments for NAFLD include statins, omega-3 fatty acids, metformin, vitamin E, and various other antidiabetics. Pharmacologic therapy should only be reserved for patients with NASH and even then only for those with advanced fibrosis and at high risk of disease progression. The first-line pharmacotherapy for NASH should be pioglitazone (off-label use outside of type 2 diabetes) or vitamin E or a combination of both.
Bugianesi alluded to pharmacological agents such as ethyl icosapentate, obethicolic acid, simtuzumab, GFT505, liraglutide and losartan, in the pipeline for treatment of fatty liver. However, these compounds still need to undergo placebo-controlled trials before being released to the population.