Evidence-Based Medicine
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2021; 13(2): 233-241
Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.233
Awareness of non-alcoholic steatohepatitis and treatment guidelines: What are physicians telling us?
David Hermanus Wessels, Zeil Rosenberg
David Hermanus Wessels, Medical Office, A.E.S., Chorley PR7 1NY, Lancashire, United Kingdom
Zeil Rosenberg, Chief Medical Office, Accelerated Enrollment Solutions, Horsham, PA 19044, United States
Author contributions: All authors editing of this paper, and approved the final version of this study.
Conflict-of-interest statement: Dr. Wessels is an employee of AES, a clinical trials site management organization conducting clinical studies on NASH, which provided funding for this work. No other conflicts are reported.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David Hermanus Wessels, MBChB, Chief Doctor, Medical Office, A.E.S., Sandringham House Ackhurst Park Foxhole Road, Chorley PR7 1NY, Lancashire, United Kingdom. dawie.wessels@globalaes.com
Received: November 23, 2020
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.