Nonalcoholic fatty liver disease (NAFLD) is commonly diagnosed in outpatient hepatology and gastroenterology practices in North America. Patients with NAFLD have steatosis, which closely resembles alcoholic liver disease, but without a significant history of alcohol consumption. Nonalcoholic steatohepatitis (NASH) refers to NAFLD accompanied by evidence of fibrosis or inflammation in the liver biopsy in addition to steatosis. NAFLD without features of NASH is generally regarded as a benign disorder; however, it is estimated that up to 20% of patients with NASH progress to end-stage liver disease.
NAFLD is diagnosed by excluding a history of significant alcohol intake and by ruling out viral, autoimmune and other liver diseases. An echogenic liver on ultrasound suggesting fat infiltration further supports the diagnosis. Finally, liver biopsy showing steatosis with or without inflammation and fibrosis is considered the gold standard for diagnosis, but in practice it is often omitted because clinicians lack treatments that are proven to alter the natural history of this condition.
Treatment for NAFLD is aimed at correcting underlying contributing factors. This includes encouraging weight loss with diet and exercise in patients who are overweight, improving control of diabetes, treating hyperlipidemia and withdrawing any medications that may be contributing to NAFLD. The use of ursodeoxycholic acid, metformin and vitamin E is under investigation and they are yet to be proved to be effective in treating this disorder. There is no more need to hesitate and you can start your treatment very soon, having spent several times less money. All you need at this point is to buy birth control Now and be sure you will be given all the best quality stuff at the reliable pharmacy of your choice.
Most retrospective descriptive studies of NAFLD have focused on patients with biopsies typical for NASH. The initial series found that NASH was associated with female sex, obesity, type II diabetes, total parenteral nutrition, jejunoileal bypass, protein calorie malnutrition, hyperlipi-demia and certain drugs. More recently, investigators have described NASH in patients who were referred to outpatient clinics for an assessment of elevated liver enzymes. In contrast to the earlier series, these newer reports showed that NASH can occur in the absence of obesity and diabetes. Recently, Matteoni et al described a heterogeneous cohort of patients with NAFLD, and showed a positive correlation between the severity of changes in the liver and clinical outcomes, including mortality.
We elected to further characterize patients with NAFLD by studying patients who were referred exclusively for raised liver enzymes. We took this approach to capture a more homogeneous study population and to further define this outpatient group, which continues to be a common clinical problem facing gastroenterologists and hepatologists.
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