Practice patterns in NAFLD and NASH: real life differs from published guidelines
Practice patterns in NAFLD and NASH: real life differs from published guidelines
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DOI：
10.1177/1756283x15611581
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发表时间：
2016-01-01
影响因子：
4.2
通讯作者：
Harrison, Stephen A.
中科院分区：
文献类型：
--
作者：
Rinella, Mary E.;Lominadze, Zurabi;Harrison, Stephen A.
工作背景：美国肝病研究协会/美国胃肠病学会/美国胃肠病协会于2012年发表的非酒精性脂肪性肝病（NAFLD）和脂肪性肝炎（NASH）管理指南建议将体重减轻、维生素E和吡格列酮作为治疗活检证实的NASH的有效疗法。然而，很少有人知道如何在美国的医生诊断NASH或是否发表的guidelines are behind.Methods：我们评估了目前的诊断和治疗模式的管理NAFLD和NASH的学术胃肠病学家和肝病学家在美国使用标准化调查，以收集有关受访者的执业环境，诊断技术，和药物使用的信息与NAFLD/NASH患者。我们邀请了482名胃肠病学家和肝病学家，主要来自学术中心，其中163人完成了调查。只有24%的医疗服务提供者常规进行肝活检，主要是血清转氨酶升高的患者。70%的人定期服用维生素E，而只有14%的人定期服用吡格列酮。尽管有相反的建议，但类似于25%的处方吡格列酮或维生素E，而没有活检证实NASH。美托洛尔的使用频率与吡格列酮相同，尽管已证明其在NASH中缺乏疗效。总的来说，40-73%的人坚持公布的指导方针，这取决于具体的问题。有没有显着的差异，在遵守胃肠病学家和hepatologist.Conclusion之间的指南：这项调查表明，临床实践模式之间的胃肠病学家和肝病学家的NASH的管理经常偏离出版的实践指南。虽然肝活检仍然是诊断NASH的金标准，但只有不到25%的受访者经常需要它来诊断NASH。我们的结论是NASH在胃肠病学和肝病学实践中诊断不足，强调需要完善非侵入性诊断工具。
Background: Management guidelines from the American Association for the Study of Liver Diseases/American College of Gastroenterology/American Gastroenterology Association published in 2012 for nonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) recommend weight loss, vitamin E and pioglitazone as effective therapies for the treatment of biopsy-confirmed NASH. However, little is known about how physicians in the US diagnose NASH or whether published guidelines are being followed.Methods: We assessed current diagnostic and treatment patterns of the management of NAFLD and NASH among academic gastroenterologists and hepatologists in the US using a standardized survey developed to collect information regarding respondents' practice environments, diagnostic techniques, and medication usage in patients with NAFLD/NASH.Results: We invited 482 gastroenterologists and hepatologists, predominantly from academic centers, of whom 163 completed the survey. Only 24% of providers routinely perform liver biopsy, predominantly among patients with elevated serum aminotransferases. Vitamin E is prescribed regularly by 70% while only 14% routinely prescribe pioglitazone. Despite recommendations to the contrary, similar to 25% prescribe pioglitazone or vitamin E without biopsy confirmation of NASH. Metformin is used as frequently as pioglitazone despite its proven lack of efficacy in NASH. Overall, 40-73% adhere to published guidelines, depending on the specific question. There was no significant difference seen in adherence to guidelines between gastroenterologists and hepatologists.Conclusion: This survey suggests that clinical practice patterns among gastroenterologists and hepatologists for the management of NASH frequently diverge from published practice guidelines. Although liver biopsy remains the gold standard to diagnose NASH, less than 25% of respondents routinely require it to make the diagnosis of NASH. We conclude that NASH is underdiagnosed in gastroenterology and hepatology practices, highlighting the need to refine noninvasive diagnostic tools.