Due to the often silent nature of symptoms, NASH sometimes goes undiagnosed.1 It is therefore important that protocols and processes are in place to help identify, diagnose and manage those with advanced fibrosis due to NASH.

NASH is strongly associated with metabolic disorders such as type 2 diabetes mellitus (T2DM) and obesity.3,4,5 As the prevalence of these conditions rises, the burden on healthcare systems is predicted to increase significantly.6 Primary care providers and specialists in metabolic health have an essential role to play in ensuring those most at risk are referred to a liver specialist.

Current professional guidelines and recommendations on the optimal care pathway for people with NASH are limited, however, as awareness increases, evidence for best practice is emerging.7,8

How clear do you feel nonalcoholic steatohepatitis referral pathways are for those working in primary care?
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  1. Sweet PH, et al. Nonalcoholic Fatty Liver Disease. Prim Care Clin Off Pract 2017;44:599–607.
  2. Goldberg D, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology 2017;152:1090–9.e1.
  3. Cortez-Pinto H, et al. Non-alcoholic fatty liver: another feature of the metabolic syndrome? Clin Nutr 1999;18:353–8.
  4. Lazo M, Clark J. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis 2008;28:339–50.
  5. Dai W, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. Medicine 2017;96:e8179.
  6. Estes C, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018;67:123–33.
  7. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016;64:1388–402.
  8. Chalasani N, et al. The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012;142:1592–609.
  9. Castera L, et al. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology 2019; doi: 10.1053/j.gastro.2018.12.036. [Epub ahead of print.
  10. Wanless I, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatol 1990;12:1106–10.

LID/IHQ/18-12//1048d(1) Date of preparation August 2019