The new guidance for managing NAFLD/NASH has been officially published. This is the official guidance by the American Association for the Study of Liver Disease (AASLD) and it is intended to provide primary care and other providers with the information they need to provide care for their patients.
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That’s great news especially for folks who are just finding out about their condition and not having any guidance. Again thanks for all you do, you are truly a pioneer. God bless.
Hi Wayne, yes indeed thank you so much for all you do. I feel it would be so important for this information to get out to all the liver organizations and their members. Each one of us needs to supply this information to all PCPs across our nation.
I know that the Global Liver Institute has a “Liver Action Network” consisting of about 12 Liver member organizations. Has this information made it out to Donna R. Cryer and the Global Liver Institute? Thanks!!
Smart/scientific approach regarding NAFLD/NASH. I think it should be applied not only in the USA. Unfortunately still some old school attitude like "your ALT level is in normal range your liver is fine go home" is present even amongst doctors.
I took the test and it says I am at 1.61. I had an ultrasound and no mention of fatty liver but they saw several calcified granulomas. I have period pain under my right rib off and on and I had my gall bladder out two years ago. My Dr. said everything is fine but I don’t feel fine. Should I seek out a hepatoligist considering my 1.61 result? Oh also my liver measured 12.5cm while in the past it measured 14.5cm. Not sure if this is significant or not. I am exercising more and eating more healthy and trying to lose weight. Not sure if I should just keep going with this or seek out a specialist.
You are in the grey area where the message is that you should have further evaluation. Here is a link to the guidance supplied by the liver specialists.
Your doc has to take all of your information into consideration but the guidance suggests getting a FibroScan to determine your liver stiffness or consider referral. Most docs probably aren't up to date as this is a new guidance and many don't worry much about early stage liver issues. Ultrasound can give useful information on fat content but only in the hands of an expert operator and it can't tell you about fibrosis. Not an easy situation but I'd try to get a liver stiffness test. Your doc is the one with the most information of course.
So my fibroSCAN showed F3 severe scarring and a CAP score of 363. However, my fibroSURE showed 50% improvement from a previous test. So my doc said we needed to do a biopsy to accurately stage the level of damage. I suggested a Magnetic resonance elastography (MRE) and he ordered a triphasic CT of the liver as their hospitals can not do MRE. He has also referred me to another hospital chain about 2 hours away to do the MRE.
My BMI is over 35 so i'm hoping the fibroSCAN is an anomaly based on my weight. Not sure what the Triphasic CT will show
The BMI can be an issue, depends on your specific anatomy. The CT is excellent for looking for tumors and such but doesn't really show scar tissue well. It will give them a chance to look at possible consequences of F3 on veins for example but it can't measure stiffness. You will need the MRE to actually answer that question. The fibrosure may be reflecting changing levels of inflammation as that can change fairly quickly. If a focus is inflammation you might ask if they have Liver Multiscan available at the 2nd hospital as it does better there than MRE.
Thanks for the info. I read up on the LMS. The closest availability is TX or OKLA!!
What about a MRI-PDFF? Also, my GI ran a Fe & TIBC via LabCorp. I read that with Medicare a MRI-PDFF is a no cost addition to the MRE. Additionally, the latest Fibrosure results were such that my scores were near normal. My PCP tells me that with low AST, ALP and ALT levels that I'm in good shape and to expect indeterminate or favorable results from my upcoming tests. He's also shocked as my triglyceride levels are low and lipid profile is actually quite good. (we joke how it looks like I'm pumping gravy) but my I've lost about 5% body weight since my initial fibrosure. Much of this is new to me as I'm generally asymptomatic although I do check some of the boxes for metabolic syndrome. i.e. low HDL, high fasting glucose, fat around the waist, and occasional high blood pressure (but this is within acceptable levels and controlled w/ meds).
The PDFF should come with the MRE. I suppose some operators might try to charge for it but it is just a calclulation. It is a more accurate measure of fat content than Fibroscan provides in their CAP result. It is good that your blood values have improved but that isn't proof that you are out of the woods. Many of us have gotten to cirrhosis without having bad blood tests.
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