title: A survey of patterns of practice and perception of NAFLD in a large sample of practicing gastroenterologists in France.
abstract: OBJECTIVE
  Most studies on non-alcoholic fatty liver disease (NAFLD) originate from tertiary care centers with an academic interest. How this emerging entity is accepted and managed by a wider body of gastroenterologists is unknown, despite significant implications for the diagnosis of at-risk subjects and the utilization of healthcare resources.
  
  
  METHODS
  We conducted a survey among 352 French, board-certified gastroenterologists from a large variety of practices to understand the clinical burden, perceived severity, and management patterns of NAFLD.
  
  
  RESULTS
  Half of participants saw >30 new cases (equal to HCV) of NAFLD and 40% >5 new cases of NASH-cirrhosis yearly. Only 20% of patients were referred by endocrinologists; conversely, gastroenterologists overwhelmingly referred NAFLD patients for assessment of metabolic co-morbidities. In patients with metabolic risk factors, a majority of physicians considered the diagnosis of NAFLD, even if other liver diseases co-existed. The diagnosis heavily relies on aminotransferases, hence patients with normal ALT are usually not diagnosed. Liver biopsy is performed for fibrosis staging but not for the diagnosis/grading of steatohepatitis, and mainly decided based on non-invasive fibrosis procedures. Pharmacological treatment is used despite a lack of clear evidence of efficacy. Physicians monitor patients themselves, usually twice a year.
  
  
  CONCLUSIONS
  NAFLD is recognized and accepted as a disease in itself with potentially severe outcomes. Most at-risk patients are currently missed because of non-referral by endocrinologists and no exploration of those with normal aminotransferases. The medical need for the diagnosis and treatment of NAFLD is real in the community of gastroenterologists at large.
authors.affiliation: Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, INSERM UMR_S 938, France. vratziu@teaser.fr
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Lawrence
authors.initials: L
authors.lastname: Serfaty
authors.forename: Jacques
authors.initials: J
authors.lastname: Denis
authors.forename: Christophe
authors.initials: C
authors.lastname: Renou
authors.forename: Patrick
authors.initials: P
authors.lastname: Delassalle
authors.forename: Carole
authors.initials: C
authors.lastname: Bernhardt
authors.forename: Gabriel
authors.initials: G
authors.lastname: Perlemuter
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy; D005234:Fatty Liver / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D005602:France; D005762:Gastroenterology; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D010818:Practice Patterns, Physicians'
chemical_list: D000410:Alanine Transaminase