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The economic burden of MASH: comparison of healthcare resource utilization and costs in patients with probable MASH, without MASH, and with diagnosed MASH.

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Vitamin E dosing study (VEDS) in patients with metabolic dysfunction-associated steatotic liver disease with elevated aminotransferases: A multicenter, randomized, placebo-controlled trial.

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Refining HEPAmet for Treatment Eligibility in Metabolic Dysfunction-Associated Steatotic Liver Disease: External Validation and Guardrail to Exclude Cirrhosis, Limit Early Disease.

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Practice patterns in NAFLD and NASH: real life differs from published guidelines.

Mary E Rinella1, Zurabi Lominadze2, Rohit Loomba3

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|January 16, 2016
PubMed
Summary

Physician practices for diagnosing and treating nonalcoholic steatohepatitis (NASH) often deviate from guidelines. Liver biopsy is underutilized, leading to potential underdiagnosis of NASH and suboptimal patient care.

Keywords:
diagnosisliver biopsynonalcoholic fatty liver diseasenonalcoholic steatohepatitispioglitazonepractice guidelinespractice patternstreatment

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Clinical Practice Research

Background:

  • Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) management guidelines recommend weight loss, vitamin E, and pioglitazone.
  • Current diagnostic and treatment patterns for NASH in the US are not well understood.

Purpose of the Study:

  • To assess current diagnostic and treatment practices for NAFLD and NASH among US academic gastroenterologists and hepatologists.
  • To evaluate adherence to published management guidelines.

Main Methods:

  • A standardized survey was developed and distributed to academic gastroenterologists and hepatologists.
  • The survey collected data on practice environments, diagnostic techniques, and medication usage for NAFLD/NASH patients.

Main Results:

  • Only 24% of surveyed physicians routinely perform liver biopsy for NASH diagnosis.
  • Vitamin E is commonly prescribed (70%), while pioglitazone is less common (14%).
  • Adherence to guidelines varies, with 40-73% compliance depending on the specific recommendation.

Conclusions:

  • Clinical practice for NASH management frequently diverges from established guidelines.
  • Underutilization of liver biopsy suggests NASH may be underdiagnosed.
  • There is a need for improved noninvasive diagnostic tools for NASH.