Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review
Date
2014
Type:
Artículo
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Journal Title
Journal ISSN
Volume Title
Publisher
WJG Press
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Abstract
AIM: To build a consensus among Chilean specialists
on the appropriate management of patients with nonalcoholic
fatty liver disease (NAFLD) in clinical practice.
METHODS: NAFLD has now reached epidemic proportions
worldwide. The optimal treatment for NAFLD has
not been established due to a lack of evidence-based
recommendations. An expert panel of members of the
Chilean Gastroenterological Society and the Chilean
Hepatology Association conducted a structured analysis
of the current literature on NAFLD therapy. The quality
of the evidence and the level of recommendations
supporting each statement were assessed according
to the recommendations of the United States Preventive
Services Task Force. A modified three-round Delphi
technique was used to reach a consensus among the
experts.
RESULTS: A group of thirteen experts was established.
The survey included 17 open-ended questions that
were distributed among the experts, who assessed the
articles associated with each question. The levels of
agreement achieved by the panel were 93.8% in the
first round and 100% in the second and third rounds.
The final recommendations support the indication of
lifestyle changes, including diet and exercise, for all
patients with NAFLD. Proven pharmacological therapies
include only vitamin E and pioglitazone, which can
be used in nondiabetic patients with biopsy-proven
nonalcoholic steatohepatitis (the progressive form ofNAFLD), although the long-term safety and efficacy of
these therapies have not yet been established.
CONCLUSION: Current NAFLD management is rapidly
evolving, and new pathophysiology-based therapies are
expected to be introduced in the near future. All NAFLD
patients should be evaluated using a three-focused approach
that considers the risks of liver disease, diabetes
and cardiovascular events.
Description
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Citation
World Journal of Gastroenterology, September 2014, vol. 20, n° 34, p. 12182-12201
Keywords
Nonalcoholic fatty liver disease, Steatosis, Evidence-based medicine