Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.233
Peer-review started: November 23, 2020
First decision: December 7, 2020
Revised: December 18, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: February 27, 2021
Processing time: 94 Days and 1.2 Hours
Medical specialist and primary care physician knowledge of non-alcoholic steatohepatitis (NASH) treatments, especially those contained in international guidelines, is important to standardize for the benefit of patient care.
We sought to document to what degree knowledge of NASH diagnostics, as recommended in United States guidelines, varied among United States specialists and primary care providers.
We sought to document to what degree knowledge of NASH diagnostics, as recommended in United States guidelines, varied among United States specialists and primary care providers.
We utilized a randomized, online national convenience survey sample of gastroenterologists, endocrinologists, and primary care physicians to inquire about their knowledge and practice regarding NASH.
While gastroenterologists were relatively well informed, endocrinologists and primary care physicians were less likely to understand the differences between NASH and non-alcoholic fatty liver disease (NAFLD), as well as undertake diagnostic testing and necessary referrals for NASH. Only 18% of primary care physicians and 30% of gastroenterologists were familiar with common indices such as the Fibrosis-4 score by which suspect NASH patients might be identified. Only 46% of endocrinologists and 42% of primary care physicians would refer a patient with a NASH profile for a NASH work-up by a specialist. Risk (25%) and inconvenience to patients (18%) were given as reasons for not referring those with suspected NASH for biopsy.
Suboptimal knowledge of NASH and NAFLD by primary care physicians and by endocrinologists, both groups to which many NASH patients would be likely to present, may impair the definitive diagnosis of NASH and actions to minimize its effects. Reversing this knowledge gap can help in identification of additional and appropriate patients for enrollment into important NASH clinical trials.
It is important to raise awareness of NASH among physicians of all kinds. Improved patient identification can not only improve care for the individual patient, but is also necessary to assure sufficient participation of confirmed NASH patients into randomized, placebo-controlled clinical trials for new treatment modalities.