APPROACH TO THE PATIENT WITH NONALCOHOLIC FATTY LIVER DISEASE
Autori:
Ivana Mikolašević, Lidija Orlić, Davor Štimac, Vojko Mavrinac, Marina Colić, Daniela Ostojić, Sandra Milić
Sažetak
Nealkoholna masna bolest jetre (engl. nonalcoholic fatty liver disease – NAFLD) čest je uzrok aletiranih jetrenih parametara. Povezanost između masne jetre i metaboličkog sindroma (MS) dobro je dokumentirana i široko prihvaćena. Ciroza kao posljedica nealkoholnog steatohepatitisa (NASH) trenutačno je druga najčešća indikacija za liječenje transplantacijom jetre u SAD-u, a pretpostavlja se da će do 2030. postati i glavnom indikacijom za transplantaciju jetre. Gastroenterolozi/hepatolozi, kao i liječnici obiteljske medicine imaju više pitanja nego odgovora kada je u pitanju NAFLD. Najčešća su pitanja koji bolesnici s NAFLD-om imaju rizik od progresije u NASH, fibrozu, cirozu jetre i hepatocelularni karcinom te kojim bolesnicima s NAFLD-om trebamo učiniti biopsiju jetre. Osim toga sve je više neinvazivnih dijagnostičkih metoda u pristupu bolesniku s NAFLD-om. Kako pristupiti ovim bolesnicima u svakodnevnoj kliničkoj praksi postalo je više umjetnost nego znanost u ovom trenutku. U ovome preglednom radu pokušat ćemo pružiti recentne preporuke kako pristupiti bolesniku s NAFLD-om.
Summary
Nonalcoholic fatty liver disease (NAFLD) has become a common cause of elevated liver tests. The association between fatty liver and metabolic syndrome (MS) is well documented and widely accepted. Cirrhosis due to nonalcoholic steatohepatitis (NASH) is currently the second most common indication for liver transplant with increasing incidence. Gastroenterologists/hepathologists and primary care physicians have more questions than answers regarding the NAFLD. The most common questions are which NAFLD patients have a risk of progression to NASH, fibrosis, cirrhosis and hepatocellular carcinoma, and which patients with NAFLD have a need for liver biopsy. In addition, a number of non-invasive diagnostic methods in the approach to the patient with NAFLD are investigated. How to approach these patients in routine clinical practice, is more of an art than a science at this time. In this article we will try to provide more recent recommendations of how to approach the patients with NAFLD.
