COMMENTARY

Top 10 Practice-Changing Articles of 2012: Gastroenterology

David A. Johnson, MD

Disclosures

January 16, 2013

In This Article

Author's Note: The year 2012 saw many valuable contributions to the field of gastroenterology. In this highlight review, I have selected (in descending order) what I believe to be the 10 articles of greatest impact for the clinical gastroenterologist. These articles cover a broad range of topics in gastrointestinal medicine and hopefully will provide the reader with meaningful clinical guidance for their patients in 2013.

The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

Chalasani N, Younossi Z, Lavine JE, et al
Am J Gastroenterol. 2012;107:811-826

Abstract

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is one of the most common types of chronic liver disease. The American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association have collaborated to issue guidelines for diagnosis and treatment. Highlights of the recommendations are as follows:

Diagnosis

  • Patients with hepatic steatosis detected on imaging should be assessed for metabolic risk factors (eg, obesity, glucose intolerance), alcohol consumption, and potentially for NAFLD.

  • Competing causes should be excluded when evaluating a patient with suspected NAFLD.

  • Routine screening for NAFLD is not recommended because of uncertainties surrounding diagnostic tests and treatment options.

  • A liver biopsy should be considered in patients with NAFLD who are at increased risk for nonalcoholic steatohepatitis (NASH) and advanced fibrosis (eg, patients with the metabolic syndrome) but should be avoided in asymptomatic patients with normal liver chemistry values.

Management

  • Weight loss of at least 3%-5% of body weight (ideally, 10%) seems to improve hepatic steatosis and possibly inflammation.

  • Metformin and ursodeoxycholic acid are not recommended.

  • Although statins are safe in patients with NAFLD, randomized, controlled trials are necessary to determine whether they can be used specifically for treatment of the disorder.

  • A recommendation for omega-3 fatty acids is premature.

  • Pioglitazone can be used in the treatment of biopsy-proven NASH; however, long-term safety and efficacy are unknown, and weight gain is a common side effect.

  • Vitamin E at a dose of 800 IU/day improves liver histologic characteristics in nondiabetic adults with biopsy-proven NASH, although some evidence exists that high-dose vitamin E increases risks for all-cause mortality and prostate cancer.

  • Use of bariatric surgery for treatment of NAFLD is premature and should be avoided in patients with cirrhosis.

Viewpoint

These up-to-date, evidence-based guidelines highlight what is known about NAFLD and management of the burgeoning number of patients with this increasingly common disorder.

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