Awareness of nonalcoholic steatohepatitis and associated practice patterns of primary care physicians and specialists

Abstract

BackgroundThe hepatic manifestation of metabolic syndrome is nonalcoholic fatty liver disease. Patients with nonalcoholic steatohepatitis, the progressive form of nonalcoholic fatty liver disease, have increased risk of fibrosis, cirrhosis and end-stage liver disease. Estimates of prevalence in the United States range from 20–30 % for nonalcoholic fatty liver disease and 2–5 % for nonalcoholic steatohepatitis; however, physician awareness of these diseases is limited. The purpose of this study was to determine the current level of physician awareness and practices in the diagnosis and management of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis within the United States.MethodsPhysicians were asked to participate in an online, 35-question survey about their awareness of various liver conditions and current practices.ResultsOf the 302 responding physicians, 152 were primary care physicians, and 150 were specialists (comprised of gastroenterologists and hepatologists). More specialists than primary care physicians reported that they were aware of the differences between nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (p < 0.001) and that they routinely screened for nonalcoholic fatty liver disease (p < 0.001) and nonalcoholic steatohepatitis (p < 0.001). Almost half of the responding primary care physicians reported being unfamiliar with the nonalcoholic fatty liver disease and nonalcoholic steatohepatitis differences even though they were aware of both, yet 58 % of those primary care physicians were treating patients with nonalcoholic fatty liver disease and/or nonalcoholic steatohepatitis. In addition, those primary care physicians who reported being unfamiliar with nonalcoholic steatohepatitis were treating an average of 3.7 patients and reported being as likely as familiar primary care physicians to treat new patients with nonalcoholic steatohepatitis. More than half of the specialists used noninvasive diagnostic test to confirm nonalcoholic steatohepatitis, and 10 % of the specialists reported treating patients with drugs not recommended by the current guidelines.ConclusionsDespite reporting they were not familiar with nonalcoholic steatohepatitis, primary care physicians reported they would likely continue to diagnose and manage patients with nonalcoholic steatohepatitis; therefore, more physician education on the recent practice guideline for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is needed.

Ethnic influence on nonalcoholic fatty liver disease prevalence and lack of disease awareness in the United States, 2011–2016

“…In addition, we could not determine if the lack of awareness was mostly due to the patients (not knowing or recalling) or the healthcare providers (not making the diagnosis or not counselling the patients). We speculate that a large part may be due to under‐diagnosis of NAFLD and/or lack of appropriate counselling by providers which follows the findings of several other studies which determined that NAFLD is an under recognized disease in the primary care setting – the care site for the majority of patients . In fact, the lack of knowledge amongst practitioners on NAFLD, its risk factors, when to screen and/or how to accurately diagnose NAFLD was highlighted in a recent study where it was found that amongst primary care physicians, the majority of liver function tests ordered were for the presence of other nonliver related chronic diseases not due to the suspicion of NAFLD, even though 26% of the patients were found to have NAFLD .…”

Healthcare Cost and Utilization in Nonalcoholic Fatty Liver Disease: Real‐World Data From a Large U.S. Claims Database

“…The overwhelming clinical burden of NAFLD is supported by general practitioners, who have a key role in the identification, risk stratification, and timely referral for specialty care in NAFLD, butmay be unfamiliar with the intricacies of the disease. (19) The American Association for the Study of Liver Diseases guidelines suggest vigilance for NAFLD, but do not provide well-defined screening recommendations for primary care providers and cost-effective methods of disease severity assessment. (20) The lack of clear guidelines is due to uncertainties surrounding cost-effectiveness of diagnostic tests and long-term benefits of screening, which are areas in significant need of further research in the hepatology community.…”

Utilization of aspirin and statin in management of coronary artery disease in patients with cirrhosis undergoing liver transplant evaluation

“…(5,6) Despite an independent relationship between CAD and chronic liver disease, (12,13) statin therapy is often underutilized in patients with chronic liver disease due to the perceived increased risk of hepatotoxicity. (22) These concerns by clinicians are often heightened in patients with cirrhosis or LT due to their complicated medical history, (31,32) overshadowing an obvious mortality benefit of statin. (33) In the current study, although CAD was common among patients with decompensated cirrhosis, only a few were aware of their diagnosis.…”