Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease offers hepatologists practical, up-to-date and expert guidance on the most topical dilemmas, difficulties and areas of controversy/difficulty surrounding this ever-increasing area of liver disease they face in daily practice. Roger Williams and Simon Taylor-Robinson, two of Europe’s leading hepatologists, have recruited leading figures from across the world to assist them, resulting in a truly international approach. Each chapter covers a specific area of difficulty, containing clear learning points and providing evidence-based expert guidance on the latest hot topics in clinical management such as: Is NAFLD different in absence of Metabolic Syndrome? Are the pros outweighed by the cons of obtaining a liver biopsy? Is progression to cirrhosis more likely in children with NAFLD? What are the dangers as well as the true benefits of bariatric surgery? How is it best to use antifibrotic agents in clinical practice? Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease provides the answers to the questions and challenges that clinicians face every day in this area. It is essential reading for hepatologists of all levels and researchers in hepatology, as well as all those involved in the care of patients with NAFLD, including gastroenterologists, pathologists and specialist hepatology nurses.
Authoritative new text from the experts in GI populationstudies This book covers both key methodological issues and the mostimportant information in the field, disease by disease. It focuseson population-based information and studies looking at principlesand approaches to diagnosis and treatment of diseases. GI Epidemiology brings together world authorities inmultiple disciplines for the very first time, to create one clearand comprehensive source. The bulk of the chapters are divided intotwo parts, covering methodological issues and the epidemiology ofspecific GI diseases. Each chapter begins with a list of keypoints, followed by a review written in a clear and simplestyle. The methodologic chapters cover evidence-based medicine,meta-analysis, systematic reviews, genetic and molecularepidemiology, clinical trials, questionnaire design, and healtheconomics. The disease-specific chapters note the current gaps inknowledge and suggest areas for further study. GI Epidemiology serves as both a useful refresher and areliable reference on the methods and techniques used inepidemiological studies for consultants and researchers ingastroenterology. It is also an invaluable tool for fellows/trainees ingastroenterology, candidates for recertification in the combineddisciplines of gastroenterology, pediatric gastroenterology andcolorectal surgery, and anyone completing MPH training.
Fatty Liver Diseases: NASH and Related Disorders is an unusual book: it combines a practical approach for students and physicians concerned with the problem with a clear overview on the causative mechanisms. It appeals to doctors and other health care workers who encounter this problem, as well as to pathologists and investigators interested in the field of liver disease. It will improve your diagnostic acumen for people with abnormal liver tests, advance your knowledge about this important subject and help with your specialist or undergraduate exams, and management of a common disorder.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease affecting approximately 25% of the global population and is commonly recognized as the hepatic manifestation of the metabolic syndrome. The histological spectrum of NAFLD ranges from isolated steatosis to non-alcoholic steatohepatitis (NASH), with risk of developing fibrosis and subsequent cirrhosis and hepatocellular carcinoma. The gold standard for diagnosing NAFLD is liver biopsy. However, because of its invasive nature, several non-invasive methods have been developed and validated in evaluating fat and fibrosis in patients with NAFLD. Liver fat content can be assessed using various methods. The conventional histopathological method consists of a visual semiquantitative approach in which the pathologist uses a four-point scale: grade 0 corresponds to fat deposition in <5% of hepatocytes and grade 1?3 (which is needed for the diagnosis of NAFLD) corresponds to ?5%. An alternate approach is to quantitatively assess steatosis using stereological point counting (SPC) – which rely on liver biopsy. However, in vivo proton magnetic resonance spectroscopy (1H-MRS) is a reliable noninvasive method that can be used to quantitatively assess total hepatic lipid content, or proton density fat fraction (PDFF). In Paper I we compared the conventional semiquantitative histological method (grade 0-3) with SPC and 1H-MRS. We found a strong positive correlation between 1H-MRS and SPC, whereas the correlations between 1H-MRS or SPC and histopathological grading were substantially weaker. Using the widely used cut-off value of PDFF ?5%, all participants were found to have steatosis (specificity 100%, sensitivity 53%). Reducing the cut-off value to 3% maintained 100% specificity while increasing sensitivity to 79%. In Paper IV we evaluated quantitative steatosis, by SPC, in 106 biopsy-proven NAFLD patients during a 20-year follow-up. SPC was independently associated with an increased risk of all-cause mortality and development of T2DM. Moreover, in the 59 patients with sequential biopsies (approximately 10 years apart), a reduction of quantitative hepatic steatosis decreased the all-time risk of developing T2DM. NASH is commonly seen as a histological feature portending a worse prognosis in NAFLD. Interestingly, no dual biopsy study has ever shown that NASH predicts fibrosis progression. Yet, NASH is seen as a surrogate marker in pharmaceutical trials – were resolution in NASH is equivalent to future resolution of fibrosis. In Paper II we conducted a long-term follow-up study (20 years) in a large cohort of biopsy-proven NAFLD patients (n=646), in a collaboration with Karolinska Institute. We could not ascertain that NASH had any effect on all-cause, or disease-specific mortality. However, higher stages of fibrosis predicted all-cause and disease specific mortality. In Paper III, we present 129 biopsy-proven NAFLD patients, in which we had prospective, longitudinal data. They were included between 1988 and 1993. All patients alive, were re-invited 2003-2005 and 2013-2015. Dual biopsies were present in 68 patients, and three consecutive biopsies were available in 33 patients. Results showed that NAFLD is a highly heterogeneous disease, with 9.3% developing end-stage liver disease and 16% progressing to advanced stages of fibrosis without any clinically significant baseline data predicting disease progression. In summary, when using 1H-MRS as a diagnostic method for NAFLD, the diagnostic cut-off should be reduced from 5% to 3%. Furthermore, quantitative amount of hepatic steatosis could be used to stratify patients with NAFLD related to future risk of developing T2DM. Moreover, we have shown that NASH does not predict future all-cause or disease-specific mortality nor end-stage liver disease, therefore a different surrogate marker should be used in clinical trials when assessing NAFLD improvement, so to not imbue false reliance in new therapies. Lastly, we have shown that NAFLD has a more dismal prognosis than previously reported, and that it is unexpectedly difficult to predict fibrosis progression in individual NAFLD patients, emphasizing the need for robust non-invasive biomarkers suitable to monitor large number of patients.
The book is a compact yet comprehensive practical resource that highlights all must-know information on non-alcoholic fatty liver disease (NAFLD). Covering the major issues dominating the field, this book offers a broad vision on NAFLD using key data for a deep and thorough understanding of the latest diagnostic methods, treatment options, potential complications, and disease management strategies to improve patient outcomes. The volume bridges the trans-disciplinary divide between hepatologists, cardiologists, nephrologists, psychiatrists, oncologists and dermatologists in order to cover the complex management of NAFLD in a single volume. It operates under a modern definition of NAFLD that acknowledges the range of presentations related to extrahepatic complications that hepatologists see in daily practice, while also delving into unanswered questions and future directions regarding treatment options. Offering practical, clinical guidance in addition to capturing the new promising therapeutic approaches in the pipeline, this book is an essential reference for clinicians, researchers and students.
The sharp rise in cases of Non-alcoholic fatty liver disease is fast becoming one of the major concerns for hepatologists worldwide. This comprehensive clinical guide explains how to diagnose NAFLD and manage patients according to the best standards of care. Contributors from the world's leading institutions concentrate on patient care, drawing on their extensive experience.
Non-alcoholic fatty liver disease (NAFLD) is a major medical challenge because of its increasing prevalence, difficulties in diagnosis, complex pathogenesis, and lack of approved therapies. In the near future, it will become the major form of chronic liver disease in adults and children and the leading indication for liver transplantation. It can be detected by noninvasive and invasive tools, and its treatment depends mainly on lifestyle modification to prevent disease progression and its related sequelae. This book provides information on NAFLD prevalence, etiology, pathogenesis, pathology, diagnosis, and treatment. Chapters cover such topics as experimental work related to the disease, other diseases related to NAFLD, and noninvasive tools for diagnosis.
In this issue, guest editors bring their considerable expertise to this important topic. Contains 20 practice-oriented topics, including metabolic syndrome associated with NASH; genetic markers and comorbidities predisposing to NASH and progressive liver disease; the role of bariatric surgery and endobariatric surgery in NASH; future treatment options and regimens for NAFLD; and more. Provides in-depth clinical reviews on non-alcoholic steatohepatitis, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
Nonalcoholic fatty liver disease (NAFLD) with a prevalence of 20-30% worldwide is characterized by the buildup of fat in the liver (liver steatosis) with no or little alcohol consumption. Its principal causes are modern diet and occidental lifestyle. It is characterized by metabolic disturbances such as insulin resistance, inflammation, and oxidative stress, considered as the hepatic manifestation of metabolic syndrome. There is no effective drug therapy for this disease; therefore, lifestyle interventions remain as the first-line treatment. Nevertheless, the adherence rates to this type of treatment are very low, so great efforts are focused at finding novel therapeutic agents for the prevention of hepatic steatosis and its progression. This book presents a systematic and comprehensive revision about NAFLD, highlighting its epidemiological and molecular aspects, as well as its prevention and treatment.
Non-alcoholic fatty liver disease (NAFLD) is a common cause of elevated liver enzymes and chronic liver disease in Western countries. NAFLD is characterized by elevated liver enzymes in the absence of alcohol consumption and secondary causes of liver disease. It is an independent predictor of future risk of cardiovascular diseases, type 2 diabetes and metabolic syndrome (hypertension, abdominal obesity, dyslipidemia, glucose intolerance). This book is a quick reference guide for medical students and professionals about NAFLD. Readers will find a summary of epidemiology, clinical features, diagnosis, imaging techniques, histopathology, and disease management. The book also presents information about NAFLD linked with hepatocellular carcinoma and guidelines for treating NAFLD in pediatric patients. Each chapter presents information in a simple, structured manner making this text an ideal handbook for supplementing hepatology modules in medical curricula.
