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

Ratziu, Vlad; Cadranel, Jean–François; Serfaty, Lawrence; Denis, Jacques; Renou, Christophe; Delassalle, Patrick; Bernhardt, C.; Perlemuter, Gabriel

doi:10.1016/j.jhep.2012.03.019

Cited by 60 publications

(73 citation statements)

References 27 publications

(28 reference statements)

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“…We therefore conducted a survey in a representative population of board certified gastroenterologists in Romania in different practice settings in order to gain better insights into the perception of NAFLD/NASH in real life gastroenterological practice. This is similar to a study performed in France and published in 2012 [8] and another more recent one realized in the USA [9]. We believe that the current findings will provide a better understanding of the NAFLD prevalence (which is probably underestimated), severity and treatment in Romania, leading to an improvement of the awareness among hepatologists/ gastroenterologists, and to a better longterm follow-up and management of this challenging/complex entity.…”

Section: Introductionsupporting

confidence: 89%

“…The aim of this survey was to assess the patterns of practice, disease awareness and recognition of NAFLD among Romanian hepatogastroenterologists and to compare them with data resulting from a similar survey conducted among French board certified gastroenterologists [8].…”

Section: Discussionmentioning

confidence: 99%

“…In Romania, there is an increased awareness of NAFLD diagnosis in patients at risk (patients with steatosis at ultrasound, obese or with diabetes despite normal transaminases) as compared to almost 40% of the French SG [8] that do not actively search for NAFLD in patients with normal ALT. In the USA, 54% of PCPs do not screen at all for NAFLD in patients with obesity and/or diabetes, while only 19% screen the majority of these patients [10].…”

Section: Therapeutic Managementmentioning

confidence: 99%

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Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists

Iacob

Ester

Lita

et al. 2016

JGLD

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Introduction: Nonalcoholic fatty liver disease (NAFLD) has an increasing incidence worldwide, reflecting the epidemics of obesity and metabolic syndrome. Data on knowledge, attitude and management by the Romanian gastroenterologists with regard to NAFLD are lacking. Methods: We assessed current diagnostic and treatment patterns of the management of NAFLD among 102 Romanian board certified gastroenterologists using a survey developed to collect information regarding participants’ clinical practice, diagnostic tools and usage of medication in patients with NAFLD. Results: 71.6% of the surveyed gastroenterologists (SG) had more than 5 years of gastroenterology practice, were university affiliated and 37.3% had predominant activity in hepatology (>60%). In Romania, 60.8% of the SG would diagnose NAFLD only if all other causes of liver disease were absent. All practitioners use a noninvasive tool for staging NAFLD, 45.1% use both serum markers and transient elastography. Liver biopsy is performed by 61.8% of the SG in the presence of a discordant result in two noninvasive methods of fibrosis evaluation. The most frequently prescribed drugs are: silymarin (88.2%), vitamin E (78.4%) and ursodeoxycholic acid (77.4%). Conclusion: The results of this survey suggest that clinical practice patterns among Romanian gastroenterologists for the diagnosis (mainly liver biopsy) and management of NAFLD frequently diverge from published practice guidelines. Nonalcoholic steatohepatitis is probably underdiagnosed, especially in patients with normal transaminase levels and is also overtreated with drugs that are not recommended in the guidelines. Abbreviations: ALT: alanine aminotransferase; BMI: body mass index; CLD: chronic liver disease; CAP: controlled attenuation parameter; ESLD: end-stage liver disease; HBV: hepatitis B virus; HCV: hepatitis C virus; HDV: hepatitis delta virus; HCC: hepatocellular carcinoma; HOMA: Homeostasis Model Assessment of Insulin Resistance; LC: liver cirrhosis; LT: liver transplantation; NAFLD: nonalcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; PCP: primary care practitioners: SG: surveyed gastroenterologists; UDCA: Ursodeoxycholic acid.

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Section: Introductionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Therapeutic Managementmentioning

confidence: 99%

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Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists

Iacob

Ester

Lita

et al. 2016

JGLD

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“…36 As clinical or biochemical markers alone are not sufficient to accurately predict the presence of NASH, multiple parameters have been combined into mathematical models to produce diagnostics algorithms to facilitate non-invasive assessment of NAFLD and its different stages. Some of such fibrosis markers are BARD score, FIB-4 test, Fibrometer, NFS and Fibrotest.…”

Section: Serum Fibrosis Markersmentioning

confidence: 99%

“…According to an Australian survey, 98% non-liver specialist were able to correctly identify NASH on the basis of LB, while according to study by Ratziu, 38% HepatoGatsroenterologist would not perform this procedure to estimate hepatic inflammation due to its invasive nature. 36,39 LB is still considered the gold standard for the prognosis by majority of physicians. LB is the only means to differentiate NASH from simple steatosis.…”

Section: Liver Biopsymentioning

confidence: 99%

Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

Choudhuri

Gupta

2017

Int J Basic Clin Pharmacol

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The aim of the present review is to understand the gap between real world clinical practices, guidelines recommendations and to propose minimum essentials that can be followed in clinical practice in NAFLD patients in India. A detailed literature search of published medical reports in English language was performed on electronic databases such as PubMed and Cochrane, from 2000 to 2016 using relevant search terms. The search yielded 25 relevant articles whose full texts were retrieved and evaluated. Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of liver disease in India. It is observed that physicians under appreciate the overlap between NAFLD and metabolic risk factors, thus missing a significant proportion of high-risk NAFLD patients. Lifestyle intervention is generally considered the first line therapy for patients with NAFLD without steatohepatitis while pharmacotherapy (in addition to lifestyle intervention) is suggested for patients with non-alcoholic steatohepatitis (NASH). Current therapies are directed towards improving the metabolic parameters which contribute to disease pathogenesis. Pharmacological therapies for NAFLD and NASH include antioxidants such as vitamin E and ursodeoxycholic acid; insulin sensitizers such as metformin and thiazolidinones, weight loss drugs like orlistat and consideration of bariatric surgery for morbidly obese patients. High degree of suspicion is necessary for diagnosing NAFLD in patients with metabolic risk factors. Further studies are required from India as genotype/clinico-pathological profile of Indian NAFLD patients differ from the western population. Further, prospective studies will fill the various missing links associated with management of NAFLD in Indian patients in a more effective manner.

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Nonalcoholic Fatty Liver Disease

Rinella

2015

JAMA

1,961

1,621

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

Cited by 60 publications

References 27 publications

Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists

Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists

Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

Nonalcoholic Fatty Liver Disease

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