Non-Alcoholic Fatty Liver Disease - ECAB Clinical Update: Gastroenterology/Hepatology

Non-alcoholic fatty liver disease is a common cause of chronic liver disease, and its incidence is rising worldwide. Understanding its pathogenesis, biochemical parameters, histological grading and staging, and its management is a vital issue in today's clinical practice. It appears to be linked directly to the growing epidemic of obesity in adults as well as in children. Thus, in a sense, NAFLD is a self-inflicted liver disease, much like alcoholic liver disease. The exact causes responsible for the development of NAFLD have not been established yet. However, some researchers consider that cluster of disorders that increases the risk of developing heart disease, diabetes, and stroke may be the factor behind development of NAFLD. Most patients with NAFLD have no symptoms or signs of liver disease at the time of diagnosis. In these patients, abnormal liver function tests are often discovered incidentally. Non-alcoholic steatohepatitis (NASH) is that stage of the spectrum that involves fat accumulation (steatosis), inflammation (hepatitis), and scarring (fibrosis) in the liver. Those who have fatty liver or hepatic steatosis with non-specific inflammation as fatty liver with non-specific inflammation generally have a benign longterm prognosis, whereas those who have NASH can progress to cirrhosis. NASH-related cirrhosis may have similar prognosis as cirrhosis from other causes. Hepatocellular carcinoma (HCC) is part of the spectrum of NAFLD, and screening for HCC seems reasonable in patients who have NASH-related cirrhosis. No established treatment is available for NAFLD. Some empiric treatment strategies have been suggested. Presumably, weight loss through exercise and diet modification along with insulinsensitizing agents will help reverse fatty infiltration of the liver. Its incidence is reportedly on the rise the world over as well as in India. Realizing its significance, there is now greater understanding of its etiology, pathogenesis, and management. The efforts of Elsevier have been directed toward addressing these aspects. Elsevier has thus pooled its existing resources with those of the internationally acclaimed Gastroenterologists of India who have chosen to share their rich clinical knowledge, experience, and expertize to serve the practitioners and patient community. Front Matter Title page Copyright ECAB Clinical Update:Gastroenterology/Hepatology Non-Alcoholic Fatty Liver Disease About the Authors Contents ECAB Clinical Update InformationNON-ALCOHOLIC FATTY LIVER DISEASE Clinical Profile of NAFLD in Indians ABSTRACT KEYWORDS Prevalence Sex and Age Body Mass Index Waist Circumference and Waist:Hip Ratio Presentation Diabetes Metabolic Syndrome Insulin Resistance HFE Gene Mutation Natural History Is It Different From The West? Non-invasive Markers for Liver Fibrosis in NAFLD ABSTRACT KEYWORDS Liver Biopsy-The Gold Standard? Imaging Techniques Biochemical Markers NashTestTM FibroTestTM SteatoTestTM New Direct Markers for Nash Cytokeratin 18 (CK-18) and Dehydroepiandrosterone Imaging for Fat, Fibrosis, and Inflammation in Non-Alcoholic Fatty Liver Disease: Recent Developments ABSTRACT KEYWORDS Introduction Imaging Modalities for Nafld Ultrasound Ultrasound Doppler Contrast Ultrasound CT Scan Value of CT in Differentiating Fat and NASH Magnetic Resonance Imaging Chemical-Shift Magnetic Resonance Imaging MR Spectroscopy SPIO-Enhanced MRI Fibroscan MR Elastography Conclusions Algorithm for Indian Patients with Nafld Case Study Imaging for Fat, Fibrosis, and Inflammation in Non-Alcoholic Fatty Liver Disease: Recent Developments Case Inference Simplified Histology of Non-Alcoholic Fatty Liver Disease ABSTRACT KEYWORDS Pathophysiology of Nash Histopathology of NASH Steatosis Steatohepatitis and Nash Hepatocellular Injury Fibrosis Approach to NAFLD in India ABSTRACT KEYWORDS Introduction Natural History of Nafld Nafld in India Guidelines for Management of Nafld in India Definition of NAFLD Defining Fatty Liver Defining NASH Defining NAFLD Associated Cirrhosis Who Should be Screened for NAFLD in India? What Should be Minimal Assessment for Patients with NAFLD? Minimal Assessment of NAFLD Optional Tests Management of NAFLD Dos and Don'ts for Patients with NAFLD What Advice Should be Given to Patients with NALFD About Alcohol Consumption? What is Risk of Statins in Patients with NAFLD? Case Studies Approach to NAFLD in India CASE STUDY 1 History Examination Conclusion CASE STUDY 2 History Examination Conclusion Management of Non-Alcoholic Fatty Liver Disease and New Therapeutic Approaches ABSTRACT KEYWORDS Diagnosis Role of Imaging Liver Biopsy Treatment of NAFLD Treatment of Associated Conditions Lifestyle Changes Diet Pharmacotherapy of NAFLD Anti-obesity Medication Insulin Sensitizers Biguanides Thiazolidinediones Lipid-lowering Drugs Antioxidants Hepatoprotectives: Ursodeoxycholic Acid Other Hepatoprotective Agents Used for NAFLD (Table 4) Role of Bariatric Surgery on NAFLD Summary Metabolic Syndrome in Non-Alcoholic Fatty Liver Disease ABSTRACT KEYWORDS Etiopathogenesis Epidemiology Controversies Regarding the Metabolic Syndrome NAFLD and Metabolic Syndrome Conclusion Other Books in This Series Portal Hypertension Irritable Bowel Syndrome Inflammatory Bowel Disease Hepatic Encephalopathy Alcoholic Liver Disease Carcinoma Gallbladder Hepatitis Malabsorption Syndrome in Tropics Portobiliary Endoscopy