COMMENTARY

Fatty Liver Takes Center Stage

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 04, 2013

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In This Article

An Epidemic of Fatty Liver Disease

Hello. I'm Dr. Bill Balistreri, Professor at Cincinnati Children's Hospital. I am here at Digestive Disease Week (DDW) in Orlando, reporting for Medscape.

The epidemic of obesity has brought significant health-related consequences. Obesity-related fatty liver disease has surpassed other disorders to become the leading cause of chronic liver disease in the United States and a major indication for liver transplantation. Abstract presentations and talks given by invited faculty highlighted key advances in our understanding of mechanisms as well as diagnostic and management approaches to patients with fatty liver disease.

Recognition that nonalcoholic fatty liver disease (NAFLD) is a major health burden for patients of all ages is increasing. For example, research presented here[1] reported the annual prevalence of NAFLD in more than 7 million individuals registered with the Veterans Administration system. NAFLD increased from less than 1% 10 years ago to 8.5% in 2011. Furthermore, a recent study[2] suggested that the prevalence of NAFLD in adolescents has more than doubled in the past 20 years.

Despite these high prevalence rates, investigators[3] identified gaps in the evaluation of incidentally identified hepatic steatosis, a frequent finding on abdominal CT scans. Therefore, they sought to determine the current decision-making practices of primary care practitioners following the incidental identification of steatosis. A total of 356 patients with reported steatosis on CT examination were identified. In the 14 months after identification, steatosis was commented on in the primary care provider follow-up notes of only 23% of these patients. There was a significant difference in the rate of follow-up when radiology reports identified fatty liver disease in the "impression" section vs the body of the report. Because radiology reporting practice significantly influences practitioner documentation rates, the investigators suggest that the presence of steatosis should be clearly recorded in the impression section.

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