Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists

Abstract

Introduction: Nonalcoholic fatty liver disease (NAFLD) has an increasing incidence worldwide, reflecting the epidemics of obesity and metabolic syndrome. Data on knowledge, attitude and management by the Romanian gastroenterologists with regard to NAFLD are lacking.

Methods: We assessed current diagnostic and treatment patterns of the management of NAFLD among 102 Romanian board certified gastroenterologists using a survey developed to collect information regarding participants’ clinical practice, diagnostic tools and usage of medication in patients with NAFLD.

Results: 71.6% of the surveyed gastroenterologists (SG) had more than 5 years of gastroenterology practice, were university affiliated and 37.3% had predominant activity in hepatology (>60%). In Romania, 60.8% of the SG would diagnose NAFLD only if all other causes of liver disease were absent. All practitioners use a noninvasive tool for staging NAFLD, 45.1% use both serum markers and transient elastography. Liver biopsy is performed by 61.8% of the SG in the presence of a discordant result in two noninvasive methods of fibrosis evaluation. The most frequently prescribed drugs are: silymarin (88.2%), vitamin E (78.4%) and ursodeoxycholic acid (77.4%).

Conclusion: The results of this survey suggest that clinical practice patterns among Romanian gastroenterologists for the diagnosis (mainly liver biopsy) and management of NAFLD frequently diverge from published practice guidelines. Nonalcoholic steatohepatitis is probably underdiagnosed, especially in patients with normal transaminase levels and is also overtreated with drugs that are not recommended in the guidelines.

Abbreviations: ALT: alanine aminotransferase; BMI: body mass index; CLD: chronic liver disease; CAP: controlled attenuation parameter; ESLD: end-stage liver disease; HBV: hepatitis B virus; HCV: hepatitis C virus; HDV: hepatitis delta virus; HCC: hepatocellular carcinoma; HOMA: Homeostasis Model Assessment of Insulin Resistance; LC: liver cirrhosis; LT: liver transplantation; NAFLD: nonalcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; PCP: primary care practitioners: SG: surveyed gastroenterologists; UDCA: Ursodeoxycholic acid.