Updated S2k clinical practice guideline on non-alcoholic fatty liver disease (NAFLD) issued by the German society of gastroenterology, digestive and metabolic diseases (DGVS)–April 2022–AWMF Registration No.: 021–025
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List of Abbreviations AASLD: American Association for the Study of Liver Diseases AFP: Alpha-Fetoprotein AHA: American Heart Association AI: Artificial Intelligence ALD: Alcohol-related Liver Disease ALT: Alanineaminotransferase API: Active pharmaceutical ingredient APASL: Asian Pacific Association for the Study of the Liver APRI: AST/platelet ratio ASH: Alcoholic Steatohepatitis AST: Aspartate aminotransferase ATI: Attenuation Imaging AUC: Area under the curve AUROC: Area under the Receiver Operating Characteristic (ROC) Curve BMI: Body-Mass-Index CAP: Controlled Attenuation Parameter CDT: Carbohydrate-Deficient Transferrin CHE: Cholinesterase CIL: Cilofexor CMV: Cytomegalovirus CT: Computed Tomography CVC: Cenicriviroc DECT: Dual-Energy CT DM: Duodenal Mucosa DPP4: Dipeptidyl Peptidase 4 %EWL: Percentage Excess Weight Loss EASL: European Association for the Study of the Liver EBV: Epstein-Barr Virus ELF: Enhanced Liver Fibrosis ELIVATE: Study of Efficacy, Safety and Tolerability of the Combination of Tropifexor & Licogliflozin and Each Monotherapy, Compared with Placebo in Adult Patients with NASH and Liver Fibrosis. EPA: Ethyl Eicosapentaenic Acid ERCP: Endoscopic Retrograde Cholangiopancreatography ESG: Endoscopic sleeve gastroplasty EtG: Ethylglucuronid F1–F4: Stages of Liver Fibrosis 1–4 FASCINATE: Study of TVB-2640 in Subjects with Nonalcoholic Steatohepatitis (NASH) FASN: Fatty Acid Synthase FF: Fat Fraction FGF: Fibroblast Growth Factor FIR: Firsocostat FLI: Fatty Liver Index FLINT: The Farnesoid X Receptor (FXR) Ligand Obeticholic Acid in NASH Treatment Trial FLIGHT-FXR: Study of Safety and Efficacy of Tropifexor (LJN452) in Patients with Non-alcoholic Steatohepatitis FPG: Fasting Plasma Glucose FXR: Farnesoid X Receptor γ-GT: Gamma-Glutamyl Transferase GI: Gastrointestinal GLP-1: Glucagon-like Peptide 1 GOT: Glutamic-Oxaloacetic Transaminase GPT: Glutamate-Pyruvate Transaminase HA: Hyaluronic Acid HAV: Hepatitis A Virus HbA1c: Hemoglobin A1c HBV: Hepatitis B Virus HCC: Hepatocellular Carcinoma HCV: Hepatitis C Virus HDL: High-Density Lipoprotein HDV: Hepatitis D Virus HEV: Hepatitis E Virus HIS: Hepatic Steatosis Index Histo: Histology HOMA: Homeostasis Model Assessment HOMA-IR: Homeostasis Model Assessment – Insulin Resistance HVPG: Hepatic-Venous Pressure Gradient iCCa: Intrahepatic CholangiIocarcinoma IDF: International Diabetes Federation IQR: Interquartile Range LDL: Low-Density Lipoprotein LFS: Liver Fat Score LSG: Laparoscopic Sleeve Gastrectomy LT: Liver Transplantation MAFLD: Metabolic Dysfunction-Associated Fatty Liver Disease MDB: Mallory-Denk-Bodies Met: Metformin mo: Month MRCP: Magnetic Resonance Cholangiopancreatography MRE: Magnetic Resonance Elastography MRI: Magnetic Resonance Imaging MRS: Magnetic Resonance Spectroscopy n3 PUFA: n-3 Polyunsaturated Fatty Acid NAFLD: Non-Alcoholic Fatty Liver Disease NAS: NAFLD Activity Score NFS: NAFLD Fibrosis Score NASH: Non-Alcoholic Steatohepatitis NASH CRN: NASH Clinical Research Network NHLBI: National Heart, Lung and Blood Institute NPV: Negative Predictive Value OAGB: One-Anastomosis Gastric Bypass OCA: Obeticholic Acid OGTT: Oral Glucose Tolerance Test OTC: Over the Counter Pat.: Patient PCOS: Polycystic ovary Syndrom PDFF: Proton Density Fat-Fraction PEth: Phosphatidylethanol PIIINP: Procollagen III peptide Pio: Pioglitazone PMID: PubMed Identifier p. o.: per os PPAR: Peroxisome Proliferator-Activated Receptor PPV: Positive Predictive Value Prosp.: Prospective PUFA: Polyunsaturated Fatty Acids RYGB: Roux-Y Gastric Bypass SCD-1: Stearoyl-CoA Desaturase 1 SG: Sleeve Gastrectomy SGLT2: Sodium Dependent Glucose Co-transporter 2 SWE: Shear-Wave Elastography %TWL: Percentage Total Weight Loss T2DM: Type 2 Diabetes mellitus TANDEM: Study of Safety, Tolerability, and Efficacy of a Combination Treatment of LJN452 and CVC in Adult Patients ith NASH and Liver Fibrosis TBWL: Total Body Weight Loss TE: Transient Elastography TG: Triclyceride THRß: Thyroid Hormone Receptor-Beta TIMP-1: Tissue Inhibitor of Metalloproteinase-1 TZD: Thiazolidindione UDCA: Ursodeoxycholic Acid US: Ultrasound VCTE: Vibration-Controlled Transient Elastography Vit C: Vitamin C Vit E: Vitamin E Supplement Supplementary Material Publication History Article published online: 13 September 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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References 653 · Cited by 30
Research works printed but not linked: 22
- [23]23. Lackner C. Hepatocellular ballooning in nonalcoholic steatohepatitis: the pathologistʼs perspective. Expert Rev Gastroenterol Hepatol 2011; 5: 223-231
- [50]50. Schirmacher P, Fleig WE, Tannapfel A et al. [Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)]. Pathologe 2004; 25: 337-348
- [139]139. Chernbumroong S, Grove JI, Astbury S et al. Advanced machine learn- ing techniques to identify a panel of biomarkers that identify nonalco- holic steatohepatitis. Hepatology (Baltimore, MD) 2017; 66: 53A-54A
- [168]168. Dietrich CF, Bamber J, Berzigotti A et al. EFSUMB-Leitlinien und Emp- fehlungen zur klinischen Anwendung der Leberelastographie, Update 2017 (Langversion). Ultraschall in Med 2017; 38: e48
- [238]238. Tacke F et al. Updated S2k Clinical… Z Gastroenterol 2022; 60: e733-e801 | © 2022. Thieme. All rights reserved.
- [239]239. Leitlinie This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. men: 5-year prospective cohort study. Hepatology 2013; 57: 1378- 1383
- [314]314. Stricker S, Rudloff S, Geier A et al. Fructosekonsum ñ freie Zucker und ihr Einfluss auf die Gesundheit. Dtsch Arztebl International 2021; 118: 71-80
- [319]319. Trovato FM, Catalano D, Martines GF et al. Mediterranean diet and non- alcoholic fatty liver disease: the need of extended and comprehensive interventions. Clin Nutr 2015; 34: 86-88
- [338]338. Mueller S, Seitz HK. Alkoholsucht und Leber: Wie wichtig ist ein Leber- screening auch für Suchttherapeuten? Suchtmedizin 2018; 20: 1-9
- [364]364. Wong VW, Wong GL, Chan AW et al. Treatment of non-alcoholic stea- tohepatitis with Phyllanthus urinaria: a randomized trial. J Gastroenter- ol Hepatol 2013; 28: 57-62
- [412]412. Mullard A. FDA rejects NASH drug. Nat Rev Drug Discov 2020; 19: 501
- [430]430. Tacke F et al. Updated S2k Clinical… Z Gastroenterol 2022; 60: e733-e801 | © 2022. Thieme. All rights reserved.
- [441]441. Dietrich A, Aberle J, Wirth A et al. Adipositaschirurgie und Therapie metabolischer Erkrankungen. Dtsch Arztebl International 2018; 115: 705-711
- [453]453. Rohde U, Hedbäck N, Gluud LL et al. Effect of the EndoBarrier Gastro- intestinal Liner on obesity and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2016; 18: 300-305
- [461]461. 458EASL clinical practical guidelines: management of alcoholic liver dis- ease. J Hepatol 2012; 57: 399-420
- [537]537. Baba HA, Theurer S, Canbay A et al. [Liver transplantation. Current as- pects of pretransplantation diagnosis and rejection]. Pathologe 2020; 41: 505-514
- [547]547. Schattenberg JM. [Non-alcoholic fatty liver disease (NAFLD)]. MMW Fortschr Med 2020; 162: 56-62
- [563]563. Nurnberg D, Jung A, Schmieder C et al. [Whatʼs the price of routine sonography -results of an analysis of costs and processes in a district hospital]. Ultraschall in Med 2008; 29: 405-417
- [564]564. Schuler A, Reuss J, Delorme S et al. [Costs of clinical ultrasound exami- nations -an economical cost calculation and analysis]. Ultraschall in Med 2010; 31: 379-386
- [565]565. Zoli M, Magalotti D, Bianchi G et al. Efficacy of a surveillance program for early detection of hepatocellular carcinoma. Cancer 1996; 78: 977- 985
- [587]587. Götz M, Anders M, Biecker E et al. [S2k Guideline Gastrointestinal Bleeding -Guideline of the German Society of Gastroenterology DGVS]. Z Gastroenterol 2017; 55: 883-936
- [599]599. Mencin AA, Lavine JE. Nonalcoholic fatty liver disease in children. Curr Opin Clin Nutr Metab Care 2011; 14: 151-157
- Authors
- Authors, & Collaborators:
- Venue
- Zeitschrift für Gastroenterologie
- Publisher
- Georg Thieme Verlag KG
- Published
- 2022-09
- Volume
- 60
- Issue
- 09
- Pages
- e733-e801
- ISSN
- 0044-2771 (ISSN-L)
- 1439-7803
- OpenAlex
- W4295757351
- Cited by
- 30
- References
- 653
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 12 · 2023: 8 · 2022: 1
- FWCI
- 4.69
- Type
- journal article
- Language
- de
- Open access
- bronze
- doi.org
- Locations
- Zeitschrift für Gastroenterologie (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, liver fibrosis, liver cirrhosis, fatty liver index, controlled attenuation parameter, fibrosis staging, fibrosis regression, cirrhosis complications, liver cancer risk, cirrhosis prevention, liver transplantation, cirrhosis decompensation
- MeSH terms
- Gastroenterology, Humans, Metabolic Diseases, Gastrointestinal Tract, Non-alcoholic Fatty Liver Disease
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