Monitoring Hepatic Steatosis

[mickeymouse42]

I’ve recently had an MRI scan of the small bowel and an MRI scan of the pancreas, liver and gallbladder as part of ongoing investigations into gut problems.

One of the observations was that I have hepatic steatosis and a fatty pancreas with a possibility of pancreatic exocrine insufficiency (PEI) -  it is thought that fat in the pancreas is a major contributor to PEI. I also have elevated triglyceride levels and it has been suggested that I look at statins.

The Cochrane review on hepatic steatosis and statins suggests that the evidence on whether statins are effective in treating hepatic steatosis is weak.

As far as I can tell, the main treatment for hepatic steatosis is better diet and more exercise. There are suggestions that the digestive enzyme drugs used in treating PEI might help. It's the Lipase enzyme that breaks down fat in the gut and the PEI drugs include lipase enzymes (in vast quantities). Unfortunately the evidence of efficacy again looks weak.

My question is how do you monitor whether hepatic steatosis (or fatty pancreas) is improving? MRI scanners give a complete picture but access to them is very limited. I suspect that an Ultrasound scan (Fibroscan) would be the best way to diagnose but though ultrasound scanners are very cheap, they are not easily accessible - GPs cannot authorise them.

Which tests can GPs authorise that will help in monitoring an improvement in hepatic steatosis? I’m not sure that liver function tests and the FIB4 test will tell you much about hepatic steatosis? Are lipid triglyceride tests the best indicator? Has anyone here ever had a lipase serum test? 

[AyrshireK]

This is a link to the NICE (National Institute for Care Excellence) gudelines to the assessment, monitoring and treatment of Non Alcohol Related Fatty Liver Disease/NAFLD/Hepatic Steatosis. nice.org.uk/guidance/ng49

You are right in that self-treatment involves good healthy diet and exercise and the BLT has a good downloadable leaflet on this. britishlivertrust.org.uk/do...

Katie

[mickeymouse42 in reply to AyrshireK]

Thanks for the reply.

In the absence of scanning technology is lowering triglyceride levels the only way you can tell whether a fatty liver is improving?

[AyrshireK in reply to mickeymouse42]

Sorry I can't answer that, the NICE guidelines will explain monitoring methods. I've no personal experience of fatty liver monitoring.