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FibroScan after endoscopy found undiagnosed NAFLD, NASH

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PHILADELPHIA — FibroScan screening for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis could significantly improve patient diagnosis and care, as data presented at the American College of Gastroenterology Annual Meeting showed that FibroScan found a significant number of undiagnosed cases.

“Nonalcoholic fatty live disease and nonalcoholic steatohepatitis are largely undiagnosed until later stages in which symptoms appears,” Woodie M. Zachry III, PhD, RPh, from Quantym Therapeutic Data in Florida, said during his presentation. “This sets up a paradigm that early detection and intervention are necessary.”

To investigate the utility of FibroScan (Echosens) as a screening tool for NAFLD and NASH, Zachry and colleagues examined patient medical records for fatty liver disease, NAFLD, NASH or other liver abnormalities within 90 days after a recent endoscopy procedure. Patients were excluded for history of any liver-related condition.

“Endoscopy centers will have a large population of people who might have high risk factors such as age and provide a large population who could easily be screened,” Zachry said.

The researchers enrolled 380 patients who underwent screening with FibroScan and 1,150 matched controls who underwent endoscopy without screening.

Zachry noted that approximately half of the patients who had valid scans (n = 367) were suspected to have NAFLD due to increased risk factors, including diabetes, high cholesterol, hypertension and BMI of 30 kg/m² or higher.

Isolated high controlled attenuation parameter (CAP) — which suggests NAFLD, according to Zachry — was present in 43.5% of screened patients, while 3.7% of patients showed isolated abnormal liver stiffness. The researchers found both elevated CAP and liver stiffness in 9.7% of patients, which could point to NASH.

During follow-up, 25 screened patients had NASH confirmed with biopsy and two patients were diagnosed with either alcoholic liver disease or NAFLD. Ten patients were lost to follow-up.

Patients who underwent screening demonstrated a higher incidence of diagnosis for fatty liver disease (5.3% vs. 1.8%; P < .001), NAFLD (4.7% vs. 1.7%; P = .002) and NASH (6.6% vs. 0.1%; P < .001) compared with the control group.

“The screening program did appear to significantly increase our detection and diagnosis of liver disease, but our enemy is follow-up care,” Zachry said. “Further public health care initiatives might benefit from educational-based initiatives, which discussion with health care professionals echoed.” – by Talitha Bennett

Reference : Zachry WM, et al. Abstract 27. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Zachry reports no relevant financial disclosures.