Die verfettete Leber in der Hausarztpraxis

Seminar / Nicht-alkoholische Fettlebererkrankung

Primary care diagnosis and treatment of nonalcoholic fatty liver disease

Die Versorgung der nicht-alkoholischen Fettlebererkrankung (NAFLD) in der allgemeinmedizinischen Praxis gestaltet sich trotz ihrer hohen Prävalenz oft schwierig. Die Krankheit ist symptomarm, und eine spezifische Medikation ist bisher nicht zugelassen. Hausärzte spielen in der hauptsächlich auf Lebensstilmaßnahmen basierenden Therapie eine wichtige Rolle.

This is a preview of subscription content, log in to check access.

Literatur

  1. 1.

    Eslam M, Newsome PN, Sarin SK et al. A new definition for metabolic associated fatty liver disease: an international expert consensus statement. J Hepatol 2020, online 8. April; doi: https://doi.org/10.1016/j.jhep.2020.03.039

  2. 2.

    Roeb E et al. S2K Leitlinie nicht alkoholische Lebererkrankungen. Z Gastroenterol. 2015;53:668–723

    CAS  Article  Google Scholar 

  3. 3.

    EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–402

  4. 4.

    Estes C et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030. J Hepatol. 2018;69:896–904

    Article  Google Scholar 

  5. 5.

    Stahl EP et al. Nonalcoholic fatty liver disease and the heart. J Am Coll Cardiology. 2019;75:948–63

    Article  Google Scholar 

  6. 6.

    Alexander M et al. Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults. BMJ. 2019;367:l5367

    Article  Google Scholar 

  7. 7.

    Targher G et al. Increased prevalence of cardiovascular disease in Type 2 diabetic patients with non-alcoholic fatty liver disease Diabetic Med. 2006;23:403–9

    CAS  Article  Google Scholar 

  8. 8.

    Bril F, Cusi K. Nonalcoholic fatty liver disease: the new complication of type 2 diabetes mellitus. Endocrinol Metab Clin North Am. 2016;45:765–81

    Article  Google Scholar 

  9. 9.

    Angulo P et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389–97

    Article  Google Scholar 

  10. 10.

    Taylor RS et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterology. 2020;158:1611–25.e12

    CAS  Article  Google Scholar 

  11. 11.

    Mofrad P et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37:1286–92

    Article  Google Scholar 

  12. 12.

    Parker C et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and non-invasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease. Gastroenterology. 2017;152:598–607

    Article  Google Scholar 

  13. 13.

    Chalasani N et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328–57

    Article  Google Scholar 

  14. 14.

    Singh S et al. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13:643–54

    Article  Google Scholar 

  15. 15.

    Grgurevic I et al. Natural history of nonalcoholic fatty liver disease: Implications for clinical practice and an individualized approach. Can J Gastroenterol Hepatol. 2020;21:1–10

    Article  Google Scholar 

  16. 16.

    Romero-Gomez M et al. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67:829–46

    Article  Google Scholar 

  17. 17.

    Ajmera V et al. Among patients with nonalcoholic fatty liver disease, modest alcohol use is associated with less improvement in histologic steatosis and steatohepatitis. Clin Gastroenterol Hepatol. 2018;16:1511–20

    Article  Google Scholar 

  18. 18.

    Chen YP et al. A systematic review and a dose—response meta-analysis of coffee dose and nonalcoholic fatty liver disease. Clin Nutr. 2019;38:2552–7

    CAS  Article  Google Scholar 

  19. 19.

    Cusi K et al. Long-term Pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med. 2016;165:305–15

    Article  Google Scholar 

  20. 20.

    Dhir G et al. Glucagon like peptide-1 receptor agonists for the management of obesity and non-alcoholic fatty liver disease: a novel therapeutic option. J Investig Med. 2018;66:7–10

    Article  Google Scholar 

  21. 21.

    Younossi ZM et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019;394:2184–96

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Prof. Dr. med. Ewert Schulte-Frohlinde.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schulte-Frohlinde, E. Die verfettete Leber in der Hausarztpraxis. MMW - Fortschritte der Medizin 162, 58–60 (2020). https://doi.org/10.1007/s15006-020-0618-1

Download citation

Keywords

  • Nonalcoholic fatty liver disease
  • nonalcoholic steatohepatitis
  • elastography
  • De Ritis ratio