Peter W. Wong, MD, FACG, Narayan Dharel, MD, Corinne C. Wong
Gastroenterology Associates of Fredericksburg, Fredericksburg, VA
Introduction: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasingly common in the United States and the Western World. In the United States, NAFLD and NASH are estimated to affect 1/3 and 1/10 Americans, respectively putting large proportion of the U.S. population at risk of advanced liver disease, cirrhosis and liver cancer. Transient Elastography or Fibroscan was approved in the United States in 2013 by the FDA as a non-invasive diagnostic test for the detection of steatosis and fibrosis in a variety of liver diseases including NAFLD. Until recently, access to Fibroscan has been limited primarily to academic research centers and tertiary care hospitals with the true status of NAFLD in the community and general U.S. population largely unknown. In this study, we report the status of NAFLD in a suburban community practice as identified by Fibroscan.
Methods: In this retrospective study, steatosis and fibrosis scores were analyzed in 489 NAFLD patients that had a Fibroscan (Fibroscan Compact 530) in a community hospital from February to November 2018. All the patients were referred for Fibroscan by gastroenterologists due to a fatty liver found on prior imaging studies by abdominal ultrasounds and / or CT scans. Patients with significant alcohol use (more than 2 drinks a day) and chronic liver disease (hepatitis B, Hepatitis C , autoimmune liver diseases and etc) were excluded from the analysis.
Results: Number of patient (percentage%)
1. *Steatosis score : S0 = 46 (9.40%), S1 = 15 (3.06%), S2 = 37 (7.56%) and S3 = 391 (79.95%)
2.** Fibrosis score : F0-F1 = 205 (41.92%), F2 = 148 (30.26%), F3 = 68 (13.90%) and F4 = 68 (13.90%)
*Steatosis scoring: S0 = no fat, S1 = mild fat, S2 = moderate fat, S3 = severe fat
**Fibrosis scoring: F0-F1 = none to minimal scarring, F2 = moderate scarring , F3 = severe scarring,
F4 = advanced fibrosis / cirrhosis
Discussion: In this general population with incidental fatty liver, an alarming number of patients of nearly 80% have severe fatty liver disease (S3) and nearly a third (27.80%) have severe to advanced fibrosis / cirrhosis. With the higher than expected significant abnormal findings from this observational study, we recommend Transient Elastography (Fibroscan) as a screening tool to all clinicians managing patients with fatty liver disease. To confirm the validity of advanced liver disease found on Fibroscan, a liver biopsy should be considered in patients with severe or advanced (S3/4) liver fibrosis.
Citation: Peter W. Wong, MD, FACG, Narayan Dharel, MD, Corinne C. Wong. P1537 - SCREENING FOR STEATOSIS AND FIBROSIS IN A GENERAL POPULATION WITH FATTY LIVER USING TRANSIENT ELASTOGRAPHY (FIBROSCAN). Program No. P1537. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.