KEYNOTE ADDRESS: NAFLD
Non-Alcoholic Fatty Liver Disease: Diagnosis and Management
Dr. Keyur Patel, MD, PhD
Associate Professor of Medicine, Department of Medicine
Division of Gastroenterology and Hepatology
University of Toronto Health Network
Dr. Patel received his Medical degree from the University of Southampton, United Kingdom and Gastroenterology/Hepatology training in Australia. He completed a 3-year post-doctoral clinical translational research fellowship in viral hepatitis at Scripps Clinic, San Diego and Duke Clinical Research Institute. He was staff Hepatologist and Associate Professor of Medicine at Duke University, until moving to UHN Toronto in 2016. His current research interests include clinical therapeutic trials for NAFLD and development of non-invasive biomarkers of fibrosis progression.
Presentation Overview:
The global prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated at 25%. Non-alcoholic steatohepatitis (NASH) affects about 20% of patients with NAFLD, and can lead to progressive liver fibrosis and cirrhosis. The incidence of liver decompensation, liver cancer, and death related to NASH cirrhosis are expected to increase 2-3 fold over the next decade. Liver biopsy is the reference standard for diagnosing NASH and fibrosis, but is invasive and prone to sampling error. Several serum tests and imaging elastography tools are now increasingly used in combination to improve non-invasive diagnostic accuracy for advanced fibrosis. Current medical management for NASH includes lifestyle intervention, treatment of metabolic disease, and in select patients, pharmacotherapy such as Vitamin E and Pioglitazone. There are currently no FDA-approved NASH drugs, but Incretins and compounds targeting metabolic, inflammatory, or fibrosis pathways, are in late phase clinical trials. Bariatric surgery can resolve NASH and improve hepatic fibrosis, but there are limited data in NAFLD cirrhosis, and planned bariatric intervention in these patients need to balance weight loss goals with risk of decompensation.