The 20% Rule of NASH Progression: The Natural History of Advanced Fibrosis and Cirrhosis Caused by NASH

Loomba, Rohit; Adams, Leon A.

doi:10.1002/hep.30946

Cited by 105 publications

(74 citation statements)

References 10 publications

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“…We recommend combining at least 2 noninvasive testing modalities, 16,20,21 These tests should also be interpreted in context of full clinical information, including physical examination, laboratory profile, and imaging findings. [22][23][24] When utilizing noninvasive tests to risk stratify patients for HCC screening, a higher cut-point threshold is desirable to maximize specificity (90%). The following cut points for VCTE and MRE may be considered for noninvasive detection of cirrhosis for purposes of HCC screening: VCTE 16.1 kPa and MRE of 5 kPa.…”

Section: Best Practice Advice 2: Patients With Nonalcoholic Fatty LIVmentioning

confidence: 99%

AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review

et al. 2020

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Nonalcoholic fatty liver disease (NAFLD) is a leading etiology for chronic liver disease with an immense public health impact and affects >25% of the US and global population. Up to 1 in 4 NAFLD patients may have nonalcoholic steatohepatitis (NASH). NASH is associated with significant morbidity and mortality due to complications of liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Recent data confirm that HCC represents the fifth most common cancer and is the second leading cause of cancer-related death worldwide, and NAFLD has been identified as a rapidly emerging risk factor for this malignancy. NAFLD-associated liver complications are projected to become the leading indication for liver transplantation in the next decade. Despite evidence that NAFLD-associated HCC may arise in the absence of cirrhosis, is often diagnosed at advanced stages, and is associated with lower receipt of curative therapy and with poorer survival, current society guidelines provide limited guidance/recommendations addressing HCC surveillance in patients with NAFLD outside the context of established cirrhosis. Limited data are presently available to guide clinicians with respect to which patients with NAFLD should undergo HCC surveillance, optimal screening tools, frequency of monitoring, and the influence of coexisting host-and disease-related risk factors. Herein we present an evidence-based review addressing HCC risk in patients with NAFLD and provide Best Practice Advice statements to address key issues in clinical management.

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Section: Best Practice Advice 2: Patients With Nonalcoholic Fatty LIVmentioning

confidence: 99%

AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review

et al. 2020

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“…Therefore, most clinical trials focus on NASH. However, it still remains an unanswered scientific question, why not all patients, but only a subset of them have a reported disease progression [20].…”

Section: Pharmacotherapy In Childhood and Adolescencementioning

confidence: 99%

Treatment of nonalcoholic fatty liver disease: from adult trials to perspectives in the management of children and adolescents

Doulberis¹,

Polyzos

Papaefthymiou

et al. 2020

Expert Opinion on Pharmacotherapy

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“…This is the equivalent of one stage of progression over 14.3 years (95%CI: 9.1-50 years) in NAFL vs. 7.1 years (95%CI: 4.8-14.3 years) for NASH. In patients with NASH, approximately 20% of those with advanced (F3) fibrosis will progress to cirrhosis, and 20% of compensated NASH cirrhotics will develop hepatic decompensation over a two-year period [17,18] .…”

Section: Nafld Nonalcoholic Steatohepatitis and The Natural History mentioning

confidence: 99%

Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a western perspective

Farrell¹,

Howell²

2020

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Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease worldwide, and represents an increasingly important cause of hepatocellular carcinoma (HCC). As the prevalence of NAFLD has increased, the burden of NAFLD-related HCC has been rising in parallel. This is particularly evident in Western countries, where NAFLD is estimated to account for 10%-59% of all HCC. NAFLD-related HCC can occur in the presence or absence of cirrhosis, and, while those with cirrhosis remain at the greatest risk, factors such as steatohepatitis, age, genetic polymorphisms, type 2 diabetes mellitus and obesity also appear have an impact on the risk of developing HCC in NAFLD. In this review, we present the epidemiology of NAFLD-related HCC from a Western perspective, highlighting gaps in current knowledge and future directions for research in this field.

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The 20% Rule of NASH Progression: The Natural History of Advanced Fibrosis and Cirrhosis Caused by NASH

Cited by 105 publications

References 10 publications

AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review

AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review

Treatment of nonalcoholic fatty liver disease: from adult trials to perspectives in the management of children and adolescents

Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a western perspective

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