Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease offers hepatologists practical, up-to-date and expert guidance on the most topical dilemmas, difficulties and areas of controversy/difficulty surrounding this ever-increasing area of liver disease they face in daily practice.
Roger Williams and Simon Taylor-Robinson, two of Europe’s leading hepatologists, have recruited leading figures from across the world to assist them, resulting in a truly international approach. Each chapter covers a specific area of difficulty, containing clear learning points and providing evidence-based expert guidance on the latest hot topics in clinical management such as:
- Is NAFLD different in absence of Metabolic Syndrome?
- Are the pros outweighed by the cons of obtaining a liver biopsy?
- Is progression to cirrhosis more likely in children with NAFLD?
- What are the dangers as well as the true benefits of bariatric surgery?
- How is it best to use antifibrotic agents in clinical practice?
Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease provides the answers to the questions and challenges that clinicians face every day in this area. It is essential reading for hepatologists of all levels and researchers in hepatology, as well as all those involved in the care of patients with NAFLD, including gastroenterologists, pathologists and specialist hepatology nurses.
List of contributors vii
Part I: Nature of the condition
1 Non-alcoholic fatty liver disease: Hype or harm? 3
Stephen H. Caldwell and Curtis K. Argo
2 NAFLD: A worldwide problem 8
Joanna K. Dowman, Geoffrey C. Farrell, and Philip Newsome
3 Is insulin resistance the principal cause of NAFLD? 15
Ian F. Godsland, Sanjeev Mehta, Shareen Forbes, Fabian Meienberg, Michael Yee, Simon D. Taylor-Robinson, and Desmond G. Johnston
4 Paediatric NAFLD: A distinct disease with the propensity for progressive fibrosis 29
Emer Fitzpatrick and Anil Dhawan
5 Non-alcoholic fatty liver disease (NAFLD) as cause of cryptogenic cirrhosis 36
Jay H. Lefkowitch
6 Is NAFLD different in absence of metabolic syndrome? 44
7 Occurrence of noncirrhotic HCC in NAFLD 50
Dawn M. Torres and Stephen A. Harrison
Part II: Factors in Disease Progression
8 Fibrosis progression: Putative mechanisms and molecular pathways 61
Wing-Kin Syn and Anna Mae Diehl
9 When is it NAFLD and when is it ALD?: Can the histologic evaluation of a liver biopsy guide the clinical evaluation? 72
Elizabeth M. Brunt and David E. Kleiner
10 Of men and microbes: Role of the intestinal microbiome in non-alcoholic fatty liver disease 82
Muhammad Bilal Siddiqui, Mohammed Shadab Siddiqui, and Arun J. Sanyal
11 Can genetic influence in non-alcoholic fatty liver disease be ignored? 91
Yang-Lin Liu, Christopher P. Day, and Quentin M. Anstee
12 Is there a mechanistic link between hepatic steatosis and cardiac rather than liver events? 103
Part III: Diagnosis and Scoring
13 How to best diagnose NAFLD/NASH? 113
14 The clinical utility of noninvasive blood tests and elastography 124
Emmanuel A. Tsochatzis and Massimo Pinzani
15 Are the guidelines - AASLD, IASL, EASL, and BSG - of help in the management of patients with NAFLD? 131
Cristina Margini and Jean-François Dufour
16 Imaging methods for screening of hepatic steatosis 138
Hero K. Hussain
17 Are the advantages of obtaining a liver biopsy outweighed by the disadvantages? 152
Jeremy F. L. Cobbold and Simon D. Taylor-Robinson
18 Screening for NAFLD in high-risk populations 161
Part IV: Value of treatment measures
19 Defining the role of metabolic physician 173
20 Should physicians be prescribing or patients self-medicating with orlistat, vitamin E, vitamin D, insulin sensitizers, pentoxifylline, or coffee? 182
Haripriya Maddur and Brent A. Neuschwander-Tetri
21 Effects of treatment of NAFLD on the metabolic syndrome 189
22 What are the dangers as well as the true benefits of bariatric surgery? 196
23 Liver transplantation: What can it offer? 203
Part V: What does the future hold?
24 Molecular antagonists, leptin or other hormones in supplementing environmental factors? 211
Jonathan M. Hazlehurst and Jeremy W. Tomlinson
25 What is the role of antifibrotic therapies in the current and future management of NAFLD? 218
Natasha McDonald and Jonathan Fallowfield
26 Developmental programming of non-alcoholic fatty liver disease 226
Jiawei Li, Paul Cordero, and Jude A. Oben