Non-alcoholic Fatty Liver Disease - Diagnosis and treatment
a literature review
DOI:
https://doi.org/10.4322/prmj.2019.011Keywords:
Non Alcoholic Fatty Liver Disease, diagnosis and therapeuticsAbstract
Purpose: To conduct a systematic review of the literature to gather the diagnostic and therapeutic methods of DHGNA. Methods: It was conducted a survey of the databases SciElo, LILACS and PubMED, in the Portuguese, English and Spanish languages, referring to the period from 2014 to 2018, using the following descriptors: “Non-alcoholic fatty liver disease”, “therapeutics” and “diagnosis”. Results: The search totalled 658 articles, which after data processing, remained 24 articles, of which 12 were in Spanish, 11 in English and 1 in Portuguese. Conclusion: The diagnosis of NAFLD is clinical and counts with laboratory and imaging exams, and the gold standard is the liver biopsy. Treatment consists primarily of lifestyle changes, mainly eating habits and physical activity. Pharmacological treatment is performed when changing life habits is ineffective. This includes several options, the most studied being vitamin E and Pioglitazone, while most other drugs remain with low levels of evidence. It is concluded, therefore, that there is still a lack of studies to increase the level of therapeutic recommendations of NAFLD.
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References
Pinto CG, Marega M, Carvalho JA, Carmona FG, Lopes CE, Ceschini FL, et al. Physical activity as a protective factor for development of non-alcoholic fatty liver in men. Einstein. 2015;13(1):34-40. http://dx.doi.org/10.1590/S1679-45082015AO2878 . PMid:25993066.
Kosmalski M, Mokros Ł, Kuna P, Witusik A, Pietras T. Changes in the immune system: the key to diagnostics and therapy of patients with non-alcoholic fatty liver disease. Cent Eur J Immunol. 2018;43(2):231-9. http://dx.doi.org/10.5114/ceji.2018.77395. PMid:30135638 .
Fleischman MW, Budoff M, Zeb I, Li D, Foster T. NAFLD prevalence differs among Hispanic subgroups: the multi‐ethnic study of atherosclerosis. World J Gastroenterol. 2014;20(17):4987-93. http://dx.doi.org/10.3748/wjg.v20.i17.4987 . PMid:24803810.
Lonardo A, Bellentani S, Argo CK, Ballestri S, Byrne CD, Caldwell SH, et al. Epidemiological modifiers of non‐alcoholic fatty liver disease: focus on high‐risk groups. Dig Liver Dis. 2015;47(12):997-1006. http://dx.doi.org/10.1016/j.dld.2015.08.004 . PMid:26454786.
Magalhães JB, Camargo RCT, Castoldi RC, Ozaki GAT, Koike TE, Garcia TA, et al. Qual a melhor conduta terapêutica não-medicamentosa para pacientes com doença hepática gordurosa não-alcoólica? Colloq Vitae. 2014;6(1):24-33. http://dx.doi.org/10.5747/cv.2014.v06 . n1.v088v2.
Dumitrascu DL, Neuman MG. Non-alcoholic fatty liver disease: an update on diagnosis. Clujul Med. 2018;91(2):147-50. PMid:29785151.
Del Valle Díaz S, Martínez MP, Vega JAS, Fondén JD. Hepatic disease due to fat deposit. Medisan. 2015;19(7):886-96.
Graffigna M, Catoira N, Soutelo J, Azpelicueta A, Berg G, Perel C, et al. Diagnóstico de esteatosis hepática por métodos clínicos, bioquímicos y por imágenes. Rev Argent Endocrinol Metab. 2017;54(1):37-46. http://dx.doi.org/10.1016/j.raem.2016.12.001 .
Coronel E, Coronel M. Esteatohepatitis no alcohólica (EHNA). Rev Gastroenterol Peru. 2016;36(1):58-65. PMid:27131942.
Lonardo A, Nascimbeni F, Maurantonio M, Marrazzo A, Rinaldi L, Adinolfi L. Nonalcoholic fatty liver disease: Evolving paradigms. World J Gastroenterol. 2017;23(36):6571-92. http://dx.doi.org/10.3748/wjg.v23.i36.6571 . PMid:29085206.
Ochoa E, Calambás F. Hígado graso no alcohólico en consulta de gastroenterología. Repert Med Cir. 2017;26(4):225-30. http://dx.doi.org/10.1016/j.reper.2017.10.005 .
Pérez G, Barrera F. Evaluación no invasiva de fibrosis en pacientes con esteatohepatitis: uso del puntaje de fibrosis en enfermedad por hígado graso no alcohólico (EHGNA). Gastroenterol Latinoam. 2018;25(1):45-9.
Dyson J, Day C. Treatment of Non-Alcoholic Fatty Liver Disease. Dig Dis. 2014;32(5):597-604. http://dx.doi.org/10.1159/000360511 . PMid:25034293.
Cotrim HP, Parise ER, Figueiredo-Mendes C, Galizzi-Filho J, Porta G, Oliveira CP. Nonalcoholic fatty liver disease Brazilian Society of Hepatology Consensus. Arq Gastroenterol. 2016;53(2):118-22. http://dx.doi.org/10.1590/S0004-28032016000200013 . PMid:27305420.
Wolff R. Controversias en el diagnóstico de enfermedad por hígado graso no alcohólico. Gastroenterol Latinoam. 2016;27(1):51-4.
Cruz R, Barrera F, Arrese M. Obesidad e hígado graso no alcohólico. Gastroenterol Latinoam. 2014;25(1):65-9.
Moctezuma-Velázquez C. Tratamiento actual de la enfermedad por hígado graso no alcohólico. Rev Gastroenterol Mex. 2018;83(2):125-33. http://dx.doi.org/10.1016/j.rgmx.2017.10.003 . PMid:29655574.
Vélez JF, Crespo GA, Restrepo JC. Tratamiento con vitamina E en pacientes con esteatohepatitis no alcohólica. Rev Col Gastroenterol. 2014;29(4):397-403.
Araneda MG, Poniachik CR, Jiménez HA, Poniachik TJ. Microbiota e hígado graso: potencial terapêutico. Gastroenterol. Latinoam. 2016;27(1):47-50.
Singh S, Osna NA, Kharbanda KK. Treatment options for alcoholic and non-alcoholic fatty liver disease: a review. World J Gastroenterol. 2017 set 28;23(36):6549-70. http://dx.doi.org/10.3748/wjg.v23.i36.6549 . PMid:29085205.
Vega DF, Marquetti PEV, Hadad AN, Álvarez CD, Matos JS, Rivera TG. Efecto del tratamiento con extracto de propóleos rojo oral en la esteatohepatitis no alcohólica. Rev Cubana Med. 2014;53(3):282-90.
Barrera MF. Nuevas estrategias farmacológicas para el tratamiento del hígado graso no alcohólico. Gastroenterol. Latinoam. 2016;27(1):55-9.
Cazzo E, Pareja JC, Chaim EA. Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review. Sao Paulo Med J. 2017;135(3):277- 95. http://dx.doi.org/10.1590/1516-3180.2016.0306311216 . PMid:28562737.
Leoni S, Tovoli F, Napoli L, Serio I, Ferri S, Bolondi L. Current guidelines for the management of non-alcoholic fatty liver disease: a systematic review with comparative analysis. World J Gastroenterol. 2018;24(30):3361-73. http://dx.doi.org/10.3748/wjg.v24.i30.3361 . PMid:30122876.
