Intended for US healthcare professionals only.

Intended for US healthcare
professionals only.

 

BIOPSY HAS TRADITIONALLY BEEN USED FOR IDENTIFICATION OF NASH BUT IS ASSOCIATED With NUMEROUS LIMITATIONS1-5

subjective

Only analyzes 1/50,000 of the liver and interpretation may differ between pathologists, therefore serial biopsies may provide inconsistent findings1-3,5

Cost

Costly procedure1 which may require additional cost and time of an interventional radiologist4

Adverse
events

Invasive procedure with a risk of rare but life- threatening complications, not ideal for monitoring patients over time1,5,6

Patient
Reluctance

Patient concerns related to the invasive nature of biopsy, as well as the potential for pain, discomfort, and complications5,6

 

CONSIDERATIONS FOR A ROUTINE WORK-UP OF PATIENTS WITH
SUSPECTED NASH7-11*

Patient presents
with abnormal liver
biochemistry

Raised liver enzymes may be a clinical indicator for liver conditions, triggering the need for additional investigation9

An elevated ALT may be the first clinical indicator of NASH and/or Advanced Fibrosis12,13

Assess presence
of fat in the liver

Ultrasound is often utilized to assess the presence of fat in the liver11‡

A higher steatosis grade may be more likely to be associated with definitive NASH vs no NASH14§

Exclude other liver
diseases

Alcoholic liver
disease

Hepatocellular
carcinoma

HBV,
HCV

Autoimmune
disease

Diagnosis based on biopsy of individuals referred for appraisal due to asymptomatic elevation of serum levels of ALT15‡

chart showing when further investigation is needed chart showing when further investigation is needed

After other liver diseases have been excluded, further investigation is needed to identify patients with NASH vs bland steatosis16

Consider
comorbidities that
may raise suspicion
of NASH

Assess patients for comorbidities common among patients with NASH

68%NASH patients with hypertension17

72%NASH patients have hyperlipidemia/
dyslipidemia17

71%NASH patients have metabolic syndrome17

82%NASH patients are obese
(BMI ≥30 kg/m2)17

Assess patient for
presence of
Advanced Fibrosis

In a study of NAFLD patients with biopsy-confirmed steatosis, 85% of those with F3 fibrosis also had definitive NASH14‡

 

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