Rationale Diagnostik bei nichtalkoholischer Steatohepatitis in der Praxis

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease affecting around 25 % of the adult population. Chronic inflammatory processes cause progressive forms of NAFLD including nonalcoholic steatohepatitis (NASH), liver fibrosis and ultimately liver cirrhosis, which is associated with the development of hepatocellular carcinoma (HCC). NASH and liver fibrosis are the major predictors for disease progression, liver associated and extrahepatic complications as well as mortality. To date, many potential drug targets have been identified, but no pharmaceutical strategy has been approved, so that NALFD therapy is still limited to lifestyle modifications (weight loss, nutrition, exercise). Despite the high and still increasing prevalence of NAFLD, screening of the general population is not feasible but should be limited to risk populations with associated comorbidities like type 2 diabetes, metabolic syndrome, obesity and arterial hypertension. In the context of available resources patients at risk should be identified in primary care settings by measurement of the liver function tests, transabdominal ultrasound and easy to use non-invasive scoring systems such as FIB-4 or NAFLD fibrosis score (NFS). As advanced stages of liver fibrosis are associated with poor prognosis, early diagnosis is crucial and specific techniques such as the transient elastography at a specialized hepatology center is needed to define the individual long-term strategy.