NAFLD (Non-Alcoholic Fatty Liver Disease) is a silent disease and it is incredibly common nowadays. It affects 28% of the global population, more than 60% of those with type 2 diabetes. There is a positive and reciprocal relationship between fatty liver disease and diabetes. And most importantly, fatty liver disease is a risk factor for cardiovascular disease, because it doubles that risk. Now we can say that fatty liver disease actually doubles a person's risk for cardiovascular disease.
Image represents Screening for advanced fibrosis
Who and How to Screen
Who is at high risk?
All three of these groups should be screened.
One of the first and most important things to do is a history and physical.
Patients with FIB-4 scores between 1.3 and 2.6 are at indeterminate risk. To help sort them out, these patients need further testing with a liver stiffness measurement. We can then see whether there are structural changes in the liver. It used to be that everyone had to have a biopsy, but this allows us to send fewer patients for biopsy.
The FibroScan is one of the best ways to test for liver stiffness and it is widely available, although not everywhere. If you don't have access to the FibroScan, work with your gastroenterologist or hepatologist to get that testing done.
If liver stiffness is low, they fall back on the right side in the low-risk category. If high, they fall into indeterminate or high risk and probably need to have an evaluation by a specialist.
It's important to remember that many patients come through with elevated transaminases or with steatosis noted on imaging. Those patients may have fatty liver disease or they might have other conditions. Make sure you take a good history to ensure that they don't have excessive alcohol intake or a risk for or history of hepatitis B or C.
If indicated, consider the possibility of autoimmune or metabolic liver disease. If those things are not present and testing is negative, you go back to the original low-risk pathway. If those things are present and testing is positive, then you probably need referral to a Liver Specialist near you.
Finally, how do we treat it? I want to focus first on the things that apply to all three groups.
We hope that this blog will help determine who you can manage in the primary care setting, who needs further fibroscan testing, and who should be seen immediately by a hepatologist.
Dr Chirayu Chokshi, Dr. Dhaval Dave, Dr. Jaydeep Patel & Dr. Darshak Shah together carry an experience of 27 years in this field & they have done more than 35000 endoscopy procedures.
Dr. Chirayu Chokshi & team is an expert in treating Non-Alcoholic Fatty Liver Disease in Vadodara, Gujarat. For more information, visit our website www.gastrovadodara.com or call us on 9081333897 / 9825795257 to book an appointment.