Organization . | Year . | First-line diagnosis test . | When to refer to hepatologist . | Noninvasive tests . |
---|---|---|---|---|
American Association for the Study of Liver Diseases (AASLD) | 2018 | Not clear in the guideline Routine screening for NAFLD in high-risk groups is not recommended | Not clear in the guideline | Diagnosis for NASH: liver biopsy Assessment for fibrosis: NFS or FIB-4 |
American Gastroenterological Association (AGA) | 2012 | Routine screening for NAFLD is not recommended | Not clear in the guideline | Metabolic syndrome can be used to target patients for liver biopsy |
European Association for the Study of the Liver (EASL) | 2016 | Ultrasound + liver enzymes for patients with risk factors | Refer patients with abnormal liver enzymes or medium-/high-risk fibrosis markers to specialist | Diagnosis for NASH: liver biopsy Assessment for fibrosis: NFS or FIB-4 |
World Gastroenterology Organization (WGO) | 2012 | Ultrasound + liver enzymes for patients with risk factors | Not clear in the guideline | Diagnosis for NASH: liver biopsy |
National Institute for Health Care and Excellence (NICE) | 2016 | Ultrasound + liver enzymes for patients with risk factors But routine liver function blood tests are not sensitive, and ultrasound is not cost-effective | Refer adults with advanced liver fibrosis to a hepatologist Refer children with suspected NAFLD to a pediatric specialist in hepatology | Assessment for advanced fibrosis: enhanced liver fibrosis (every 2–3 years) |
Organization . | Year . | First-line diagnosis test . | When to refer to hepatologist . | Noninvasive tests . |
---|---|---|---|---|
American Association for the Study of Liver Diseases (AASLD) | 2018 | Not clear in the guideline Routine screening for NAFLD in high-risk groups is not recommended | Not clear in the guideline | Diagnosis for NASH: liver biopsy Assessment for fibrosis: NFS or FIB-4 |
American Gastroenterological Association (AGA) | 2012 | Routine screening for NAFLD is not recommended | Not clear in the guideline | Metabolic syndrome can be used to target patients for liver biopsy |
European Association for the Study of the Liver (EASL) | 2016 | Ultrasound + liver enzymes for patients with risk factors | Refer patients with abnormal liver enzymes or medium-/high-risk fibrosis markers to specialist | Diagnosis for NASH: liver biopsy Assessment for fibrosis: NFS or FIB-4 |
World Gastroenterology Organization (WGO) | 2012 | Ultrasound + liver enzymes for patients with risk factors | Not clear in the guideline | Diagnosis for NASH: liver biopsy |
National Institute for Health Care and Excellence (NICE) | 2016 | Ultrasound + liver enzymes for patients with risk factors But routine liver function blood tests are not sensitive, and ultrasound is not cost-effective | Refer adults with advanced liver fibrosis to a hepatologist Refer children with suspected NAFLD to a pediatric specialist in hepatology | Assessment for advanced fibrosis: enhanced liver fibrosis (every 2–3 years) |
FIB-4, Fibrosis-4 Index; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NFS, NAFLD fibrosis score. Adapted from “Preparing for the NASH Epidemic: A Call to Action” (62).