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New AASLD Practice Guidelines Provide New Insights for Diagnosing and Treating Non-Alcoholic Fatty Liver Disease and Liver Cancer

A new Practice Guideline and Practice Guidance in Hepatology will help improve the diagnosis and treatment of patients with liver cancer as well as patients with non-alcoholic fatty liver disease (NAFLD), which can lead to liver cancer and is characterized by the build-up of extra fat in liver cells often due to obesity and diabetes.

Thursday, January 25, 2018 2:33 pm EST
"Therapies for Advanced Stage Hepatocellular Carcinoma with Macrovascular invasion or Metastatic Disease: A Systematic Review and Meta-analysis."

A new Practice Guideline and Practice Guidance in Hepatology will help improve the diagnosis and treatment of patients with liver cancer as well as patients with non-alcoholic fatty liver disease (NAFLD), which can lead to liver cancer and is characterized by the build-up of extra fat in liver cells often due to obesity and diabetes.

Around the globe, there is an increasing burden of NAFLD and liver cancer, or hepatocellular carcinoma (HCC). A guidance document developed by a panel of experts to help clinicians understand and implement the most recent evidence related to NAFLD was commissioned by the American Association for the Study of Liver Diseases (AASLD). As an update to the Practice Guideline published in 2012 in conjunction with the American Gastroenterology Association and the American College of Gastroenterology, it provides more details about the value of lifestyle modification as a treatment of NAFLD and offers additional guidance concerning when to consider weight-loss surgery.

“Regarding diagnosis, this document provides guidance to clinicians with up-to-date information about working up individuals with suspected NAFLD, including when to consider liver biopsy. It also elaborates non-invasive tests for NAFLD,” said lead author Naga Chalasani, MD, FAASLD, of the Indiana University School of Medicine. “Over the past 5 years since the 2012 Guideline, there have been important developments in our understanding related to noninvasive assessment with vibration controlled transient elastography and magnetic resonance elastography.”

Experts present official recommendations of the AASLD on the surveillance, diagnosis, and treatment of HCC in an updated Practice Guideline. The guideline focuses on a broad spectrum of clinical practice, including surveillance of patients with cirrhosis (or liver scarring) for HCC, establishing the diagnosis of HCC, and various therapeutic options for the treatment of HCC. The current guideline was developed in compliance with the Institute of Medicine standards for trustworthy practice guidelines using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Multiple systematic reviews of the literature were conducted to support the recommendations in this practice guideline. An enhanced understanding of the guidelines can be obtained by reading the applicable portions of the systematic reviews.

“The updated HCC guideline is really focused on screening, diagnosis, and treatment of HCC. Our writing group worked to identify and address the most important clinical questions using what’s called the Grading of Recommendation Assessment, Development and Evaluation (or GRADE) approach with systematic reviews to answer these key questions,” said lead author Julie Heimbach, MD, of the Mayo Clinic, in Rochester, MN. “When compared with the previous guideline, notable changes include a surveillance guideline to recommend ultrasound plus alpha-fetoprotein—a standard tumor marker for HCC—instead of ultrasound alone, as well as the incorporation of recent studies for HCC informing the role of liver-directed therapies and newer systemic therapies—lenvatinib, regorafenib, and nivolumab.”

The three new systematic reviews were performed to provide the evidence base to attempt to answer some of the key questions addressed in the new HCC guideline. One investigates the available evidence on the optimal imaging for the diagnosis of HCC. Another analyzes the published data on treatments for advanced stage HCC, while the final new systematic review focuses on the evidence supporting the use of bridging therapies for waitlisted liver transplant candidates with HCC.

Additional Information

Articles:

“The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases.” Naga Chalasani, Zobair Younossi, Joel E. Lavine, Michael Charlton, Kenneth Cusi, Mary Rinella, Stephen A. Harrison, Elizabeth M. Brunt, and Arun J. Sanyal. Hepatology; Published Online: 10.1002/hep.29367*** (DOI: ***).

“AASLD Guidelines for the Treatment of Hepatocellular Carcinoma.” Juie K. Heimbach, Laura M. Kulik, Richard Finn, Claude B. Sirlin, Michael Abecassis, Lewis R. Roberts, Andrew Zhu, M. Hassan Murad, and Jorge Marrero.

“Imaging for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.” Lewis R. Roberts, Claude B. Sirlin, Feras Zaiem, Jehad Almasri, Larry J. Prokop, Julie K. Heimbach, M. Hassan Murad, and Khaled Mohammed.

“Therapies for Advanced Stage Hepatocellular Carcinoma with Macrovascular invasion or Metastatic Disease: A Systematic Review and Meta-analysis.” Richard S. Finn, Andrew X. Zhu, Wigdan Farah, Jehad Almasri, Feras Zaiem, Larry J Prokop, Mohammad Hassan Murad, MD, and Khaled Mohammed.

“Therapies for Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation: A Systematic Review and Meta-Analysis.” Laura Kulik, Julie K. Heimbach, Feras Zaiem, Jehad Almasri, Larry J Prokop, Zhen Wang, M. Hassan Murad, and Khaled Mohammed.

 

URLs Upon Publication:

http://onlinelibrary.wiley.com/doi/10.1002/hep.29367/full

 

http://onlinelibrary.wiley.com/doi/10.1002/hep.29086/full

 

http://onlinelibrary.wiley.com/doi/10.1002/hep.29487/full

 

http://onlinelibrary.wiley.com/doi/10.1002/hep.29486/full

 

http://onlinelibrary.wiley.com/doi/10.1002/hep.29485/full

 

About the Journal

Hepatology is the premier publication in the field of liver disease, publishing original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism. Hepatology is published on is published by Wiley on behalf of the American Association for the Study of Liver Diseases (AASLD). For more information, please visit http://wileyonlinelibrary.com/journal/hep.

About Wiley

Wiley, a global research and learning company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 210 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com.

 

 

 

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