Real-life Perception and Practice Patterns of NAFLD/NASH in Romania: Results of a Survey Completed by 102 Board-certified Gastroenterologists.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) has an increasing incidence worldwide, reflecting the epidemics of obesity and metabolic syndrome. Data on knowledge, attitude and management by the Romanian gastroenterologists with regard to NAFLD are lacking.


METHODS
We assessed current diagnostic and treatment patterns of the management of NAFLD among 102 Romanian board certified gastroenterologists using a survey developed to collect information regarding participants' clinical practice, diagnostic tools and usage of medication in patients with NAFLD.


RESULTS
71.6% of the surveyed gastroenterologists (SG) had more than 5 years of gastroenterology practice, were university affiliated and 37.3% had predominant activity in hepatology (>60%). In Romania, 60.8% of the SG would diagnose NAFLD only if all other causes of liver disease were absent. All practitioners use a noninvasive tool for staging NAFLD, 45.1% use both serum markers and transient elastography. Liver biopsy is performed by 61.8% of the SG in the presence of a discordant result in two noninvasive methods of fibrosis evaluation. The most frequently prescribed drugs are: silymarin (88.2%), vitamin E (78.4%) and ursodeoxycholic acid (77.4%).


CONCLUSIONS
The results of this survey suggest that clinical practice patterns among Romanian gastroenterologists for the diagnosis (mainly liver biopsy) and management of NAFLD frequently diverge from published practice guidelines. Nonalcoholic steatohepatitis is probably underdiagnosed, especially in patients with normal transaminase levels and is also overtreated with drugs that are not recommended in the guidelines.
Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. msiacob@gmail.com.
Speranta
S
Iacob
Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Carmen
C
Ester
Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Mihaela
M
Lita
Service Hépato-gastroentérologie,Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, UMR_S 938, INSERM - CDR Saint Antoine, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
Vlad
V
Ratziu
Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Liana
L
Gheorghe
D001291:Attitude of Health Personnel; D001706:Biopsy; D002568:Certification; D003951:Diagnostic Errors; D000072102:Gastroenterologists / Q000523:psychology* / Q000639:trends; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008111:Liver Function Tests; D000069342:Medical Overuse; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010465:Perception; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D012383:Romania / Q000453:epidemiology; D013044:Specialty Boards