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Printable Handouts
Navigable Slide Index
- Introduction
- Conflicts of interest
- NAFLD is a global problem
- NAFLD: driver of liver-related burden of disease
- Managing NAFLD in 3 simple steps (1)
- Key concepts
- MR-based proton density fat fraction estimation of steatosis
- Ultrasound attenuation steatosis correlate
- Diagnostic accuracy of CAP scores
- Diagnostic performance of CAP
- Managing NAFLD in 3 simple steps (2)
- Key concepts in NASH
- Cirrhosis development
- Increased risk of mortality by fibrosis stage
- FIB4: non-invasive way to detect fibrosis
- Cardiovascular outcomes in NASH are linked to fibrosis stage
- Liver stiffness as a measure of fibrosis
- Diagnostic performance of fibroscan
- Fibroscan predicts overall survival
- Magnetic resonance elastography
- Assessing fibrosis noninvasively
- Work up of NAFLD
- NAFLD with fibrosis in a general population (Rotterdam study)
- Prevalence of NAFLD and NASH in T2DM
- Recap
- Managing NAFLD in 3 simple steps (3)
- Restoring health for patients with NAFLD
- Key concepts in approach to treatment of NASH
- Access to healthy foods is limited in areas of greatest obesity
- Weight loss (WL) can improve histology
- Bariatrics is a viable option for some patients
- Current status of drug treatment - impact on NASH resolution
- Fibrosis improvement with current agents
- Many other agents appear promising
- Fibrosis improvement by ≥1 stage with no worsening of NASH
- Pharmacological-bariatric therapy is improving
- GLP-1 receptor agonists have potential for cardio-metabolic & liver-benefits
- SGLT2 inhibitors & cardiac-metabolic-renal-liver outcome improvement
- Leveraging varying mechanisms to build synergy
- Current trials for NASH registered on ClinicalTrials.gov
- What it will take to reduce the burden of NAFLD
- Summary
Topics Covered
- NAFLD as a global problem and driver of liver-related burden of disease
- Managing NAFLD in 3 simple steps
- Diagnostic accuracy and performance (CAP)
- Increased risk of mortality by fibrosis stage
- Restoring health for patients with NAFLD
- Key concepts in approach to treatment of NASH
- Various therapeutic options & clinical trials for treatment of NASH
Talk Citation
Sanyal, A.J. (2019, August 29). NASH: evaluation and treatment [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 9, 2024, from https://doi.org/10.69645/PMXR1513.Export Citation (RIS)
Publication History
Financial Disclosures
- Professor Arun Sanyal owns stock in Exhalenz, Akarna, GenFit, Hemoshear, Durect, Indalo, and TIZIANA, and is employed by Sanyal Bio. He is a consultation advisor for Conatus, Gilead, malinckrodt, Pfizer, Salix, Uptodate, Boehringer, Ingelhiem, Novartis, Nimbus, Merck, Hemoshear, Lilly, Novo Nordisk, Ardelyx, Terns, ENYO, Birdrock, ALBIREO, SANOFI, JANNSEN, TAKEDA, ZYDUS, AMRA, POXEL, SERVIER, SECOND GENOME, and GENERAL ELECTRIC. He is a consultant and PI of ongoing trials in GenFit, Echosens-Sandhill, and Sequana. He is the PI of the Immuron trial for alcoholic hepatitis as part of NIAAA funded TREAT consortium. Immuron will also provide drug and no additional funding. He has provided advice, but taken no personal remuneration, for companies Intercept, Galectin, Fractyl, Durect, Indalo, Allergan, Chemomab, Affimmune, Teva, BASF, PERSPECTUM, and 89 BIO. VCU (and Dr. Sanyal as the VCU inventor) have a joint patent with OWL on lipidomic profile of NASH but I have no direct COI with OWL. He receives research grants from Gilead, malinckrodt, Salix, Novartis, Galectin, Bristol Myers, and Sequana. Conatus will provide drug and lab costs for a NIAAA sponsored study of a caspase inhibitor for alcoholic hepatitis, though he has no personal financial conflict of interest. Echosens has provided a fibroscan machine for dedicated research use for NASH related studies via NIDDK NASH CRN. He receives royalties from Elsevier and Uptodate.
A selection of talks on Gastroenterology & Nephrology
Transcript
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0:00
Hello, my name is Dr. Arun Sanyal.
I'm a Professor of Medicine,
Physiology and Molecular Pathology in the division of
Gastroenterology and Hepatology at Virginia Commonwealth University, School of Medicine.
Today, I will talk about "NASH and its Evaluation and Treatment".
0:22
Here are my conflicts of interest.
0:27
So a good place to start this discussion is to talk about the global burden of NASH.
As you can see from this map of the world,
there is a high prevalence of
nonalcoholic fatty liver disease or NAFLD throughout the world.
Approximately a quarter of the population
in many different countries has excess fat in their liver.
The prevalence is very high in
North America but probably highest in the Middle East and South America.
Whereas in Africa the prevalence is a little bit lower.
The reason we worry about this is because
cirrhosis-related outcome in people with nonalcoholic fatty liver disease is increasing,
and dynamic models of the disease indicate that by
2030 the number of people living with cirrhosis will almost triple.
The number of people with decompensated cirrhosis,
due to fatty liver disease,
will rise from about a hundred thousand currently to about 300,000.
Remember that liver transplant is an option only when an organ is available,
and many patients with NASH may not even qualify for
a liver transplant due to comorbidities which we'll talk about in a minute.
So this is a major public health problem for which we need solutions.