Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review

doi:10.3748/wjg.v20.i34.12182

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Evidence-Based Medicine

World J Gastroenterol. Sep 14, 2014; 20(34): 12182-12201
Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12182

Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review

Juan P Arab, Roberto Candia, Rodrigo Zapata, Cristián Muñoz, Juan P Arancibia, Jaime Poniachik, Alejandro Soza, Francisco Fuster, Javier Brahm, Edgar Sanhueza, Jorge Contreras, M Carolina Cuellar, Marco Arrese, Arnoldo Riquelme

Juan P Arab, Roberto Candia, Alejandro Soza, M Carolina Cuellar, Marco Arrese, Arnoldo Riquelme, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile

Rodrigo Zapata, Sección de Gastroenterología, Hospital del Salvador, Escuela de Medicina, Universidad de Chile, 7500922 Santiago, Chile

Rodrigo Zapata, Edgar Sanhueza, Jorge Contreras, Unidad de Gastroenterología, Universidad del Desarrollo, Clínica Alemana, 7650568 Santiago, Chile

Cristián Muñoz, Unidad de Trasplante Hepático, Hospital del Salvador, Unidad de Gastroenterología, Clínica Las Lilas, 7510524 Santiago, Chile

Juan P Arancibia, Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile, 8380456 Santiago, Chile

Jaime Poniachik, Javier Brahm, Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Escuela de Medicina, Universidad de Chile, 8380456 Santiago, Chile

Francisco Fuster, Digestive Diseases Unit, Clínica Reñaca, 2540364 Viña del Mar, Chile

Javier Brahm, Gastroenterology Department, Clínica Las Condes, 6770128 Santiago, Chile

Arnoldo Riquelme, Centre for Medical Education, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile

Author contributions: Arab JP, Candia R, Arrese M and Riquelme A designed the survey and coordinated the expert panel; Arab JP, Candia R, Zapata R, Muñoz C, Arancibia JP, Poniachik J, Soza A, Fuster F, Brahm J, Sanhueza E and Contreras J participated in the panel; Arab JP, Candia R, Cuellar MC, Arrese M and Riquelme A wrote the manuscript; all of the authors reviewed and approved the final draft.

Supported by (in part) Chilean Society of Gastroenterology; Grants from the Fondo Nacional De Ciencia y Tecnología de Chile, FONDECYT 1110455 to Arrese M and 1120652 to Riquelme A; and the Comisión Nacional de Investigación, Ciencia y Tecnología, CONICYT, basal project CARE Chile UC

Correspondence to: Arnoldo Riquelme, MD, MMedEd, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, 8330024 Santiago, Chile. a.riquelme.perez@gmail.com

Telephone: +56-2-23543820 Fax: +56-2-26397780

Received: December 29, 2013
Revised: March 27, 2014
Accepted: April 27, 2014
Published online: September 14, 2014

Core Tip

Core tip: Current nonalcoholic fatty liver disease (NAFLD) management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers risks of liver disease, diabetes and cardiovascular events. The final recommendations of this consensus support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies only consider vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not been established.