Adaptation of Clinical Practice Guideline for Assessment of Liver Fibrosis in Patients with Non Alcoholic Fatty Liver Disease in Isfahan Province
Abstract
Non‑alcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis (accumulation of fat in the liver to over 5% of its weight) in the absence of secondary causes of fat accumulation in the liver such as excessive alcohol use. NAFLD is divided into two types: non‑alcoholic fatty liver (NAFL) and non‑alcoholic steatohepatitis (NASH). Therefore, in this clinical guideline, we sought to determine general and important policies for this disease and modify its managment approaches. We adapted this guideline for the management of NAFLD in Isfahan Province. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of the Iranian Association of Gastroenterology and Hepatology. Biopsy is recommended as the most reliable method (gold standard) to diagnose steatohepatitis and fibrosis in patients with NAFLD. NAFLD fibrosis score (NFS) and fibrosis‑4 (FIB‑4) are recommended as the test with the highest predictive value for advanced fibrosis in patients with NAFLD compared to other serologic tests. Among the noninvasive methods used to assess liver fibrosis, transient elastography (TE) is preferable to other methods.
International Journal of Preventive Medicine 15():27, May 2024. | DOI: 10.4103/ijpvm.ijpvm_284_22
Corresponding Author: Dr. Mohammad Jafari
E‑mail: Jafari274@gmail.com
You can also search for this author in: PubMed Google Scholar
Keywords
Full Text:
PDFReferences
Lim JK, Flamm SL, Singh S, Falck‑Ytter YT, Gerson L,
Hirano I, et al. American Gastroenterological Association
Institute guideline on the role of elastography in the evaluation
of liver fibrosis. Gastroenterology 2017;152:1536‑43.
Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K,
Rinella M, et al. The diagnosis and management of nonalcoholic
fatty liver disease: Practice guidance from the American
Association for the Study of Liver Diseases. Hepatology
;67:328‑57.
LaBrecque DR, Abbas Z, Anania F, Ferenci P, Khan AG,
Goh K‑L, et al. World Gastroenterology Organisation global
guidelines: Nonalcoholic fatty liver disease and nonalcoholic
steatohepatitis. J Clin Gastroenterol 2014;48:467‑73.
Watanabe S, Hashimoto E, Ikejima K, Uto H, Ono M, Sumida Y,
et al. Evidence‑based clinical practice guidelines for nonalcoholic
fatty liver disease/nonalcoholic steatohepatitis. J Gastroenterol
;50:364‑77.
Byrne CD, Targher G. EASL–EASD–EASO Clinical Practice
Guidelines for the management of non‑alcoholic fatty liver
disease: Is universal screening appropriate? Diabetologia
;59:1141‑4.
National Institute for Health and Clinical Excellence (NICE).
Non‑Alcoholic Fatty Liver Disease (NAFLD): Assessment and
Management (NG49). London: National Institute for Health and
Clinical Excellence (NICE); 2020:1-16.
Collaboration A. The ADAPTE Process: Resource Toolkit for
Guideline Adaptation. Version 2.0. Berlin: Guideline International
Network; 2010:1-95.
Kavanagh BP. The GRADE system for rating clinical guidelines.
PLoS Med 2009;6:e1000094. doi: 10.1371/journal.pmed.
Wong VWS, Chan WK, Chitturi S, Chawla Y, Dan YY,
Duseja A, i. Asia–Pacific working party on non-alcoholic fatty
liver disease guidelines 2017—Part 1: Definition, risk factors and
assessment. J Gastroenterol Hepatol 2018;33:70‑85.
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. Obesity Facts
;9:65‑90.
Leoni S, Tovoli F, Napoli L, Serio I, Ferri S, Bolondi L. Current
guidelines for the management of non‑alcoholic fatty liver
disease: A systematic review with comparative analysis. World J
Gastroenterol 2018;24:3361‑73.
Lonardo A, Nascimbeni F, Targher G, Bernardi M, Bonino F,
Bugianesi E, et al. AISF position paper on nonalcoholic fatty
liver disease (NAFLD): Updates and future directions. Dig Liver
Dis 2017;49:471‑83.
Lee J, Vali Y, Boursier J, Spijker R, Anstee QM, Bossuyt PM,
et al. Prognostic accuracy of FIB-4, NAFLD fibrosis score and
APRI for NAFLD-related events: A systematic review. Liver Int
;41:261‑70.
Berzigotti A, Tsochatzis E, Boursier J, Castera L, Cazzagon N,
Friedrich‑Rust M, et al. EASL Clinical Practice Guidelines on non‑invasive tests for evaluation of liver disease severity and
prognosis–2021 update. J Hepatol 2021;75:659‑89.
Rinella ME, Neuschwander‑Tetri BA, Siddiqui MS,
Abdelmalek MF, Caldwell S, Barb D, et al. AASLD practice
guidance on the clinical assessment and management of
nonalcoholic fatty liver disease. Hepatology 2023;77:1797‑835.
LaBrecque DR, Abbas Z, Anania F, Ferenci P, Khan AG,
Goh K‑L, et al. World Gastroenterology Organisation global
guidelines: Nonalcoholic fatty liver disease and nonalcoholic
steatohepatitis. J Clin Gastroenterol 2014;48:467-7.
Lucero C, Brown RS Jr. Noninvasive measures of liver
fibrosis and severity of liver disease. Gastroenterol Hepatol
;12:33‑40.
Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U,
et al. Diagnosis of nonalcoholic fatty liver disease in children
and adolescents: Position paper of the ESPGHAN Hepatology
Committee. J Pediatr Gastroenterol Nutr 2012;54:700‑13.
Leroy V, Hilleret M‑N, Sturm N, Trocme C, Renversez J‑C,
Faure P, et al. Prospective comparison of six non‑invasive
scores for the diagnosis of liver fibrosis in chronic hepatitis C.
J Hepatol 2007;46:775‑82.
Naveau S, Gaudé G, Asnacios A, Agostini H, Abella A,
Barri-Ova N, et al. Diagnostic and prognostic values of
noninvasive biomarkers of fibrosis in patients with alcoholic
liver disease. Hepatology 2009;49:97‑105.
Becker L, Salameh W, Sferruzza A, Zhang K, Chen R,
Malik R, et al. Validation of hepascore, compared with
simple indices of fibrosis, in patients with chronic hepatitis C
virus infection in United States. Clin Gastroenterol Hepatol
;7:696‑701.
Safadi R, Braun M, Francis A, Milgrom Y, Massarwa M,
Hakimian D, et al. Randomised clinical trial: A phase 2 doubleblind study of namodenoson in non-alcoholic fatty liver disease
and steatohepatitis. Aliment Pharmacol Ther 2021;54:1405‑15.
Loria P, Adinolfi L, Bellentani S, Bugianesi E, Grieco A,
Fargion S, et al. Practice guidelines for the diagnosis and
management of nonalcoholic fatty liver disease: A decalogue
from the Italian Association for the Study of the Liver (AISF)
Expert Committee. Dig Liver Dis 2010;42:272‑82.
Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V,
Castera L, et al. EFSUMB guidelines and recommendations
on the clinical use of liver ultrasound elastography, update
(long version). Ultraschall Med 2017;38:e16‑47.
Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia‑Tsao G,
Rubin J, et al. Elastography assessment of liver fibrosis: Society
of radiologists in ultrasound consensus conference statement.
Radiology 2015;276:845‑61.
Tacke F, Canbay A, Bantel H, Bojunga J, de Laffolie J, Demir M,
et al. Updated S2k clinical practice guideline on non‑alcoholic
fatty liver disease (NAFLD) issued by the German society of
gastroenterology, digestive and metabolic diseases (DGVS)–
April 2022–AWMF registration No.: 021–025. Z Gastroenterol
;60:e733‑801.
Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR,
et al. WFUMB guidelines and recommendations for clinical use
of ultrasound elastography: Part 3: Liver. Ultrasound Med Biol
;41:1161‑79.
Li Y, Huang YS, Wang ZZ, Yang ZR, Sun F, Zhan SY, et al.
Systematic review with meta-analysis: The diagnostic accuracy
of transient elastography for the staging of liver fibrosis in
patients with chronic hepatitis B. Aliment Pharmacol Ther
;43:458‑69.
Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD.
Liver biopsy. Hepatology 2009;49:1017‑44.
Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V,
Hollywood C, et al. Guidelines on the use of liver biopsy in
clinical practice from the British Society of Gastroenterology,
the Royal College of Radiologists and the Royal College of
Pathology. Gut 2020;69:1382‑403.
Wendum D, Lacombe K, Chevallier M, Callard P, Valet F,
Miailhes P, et al. Histological scoring of fibrosis and activity
in HIV‑chronic hepatitis B related liver disease: Performance
of the METAVIR score assessed on virtual slides. J Clin Pathol
;62:361‑3.