Displaying One Session

PARALLEL SESSION Webcast
Session Type
PARALLEL SESSION
Channel
Paris
Date
22.02.2020, Saturday
Session Time
08:30 - 10:00

Introduction and emerging imaging technologies for NAFLD/NASH

Session Type
PARALLEL SESSION
Date
22.02.2020, Saturday
Session Time
08:30 - 10:00
Channel
Paris
Lecture Time
08:30 - 08:55

Abstract

Background and Aims

Non-alcoholic fatty liver disease (NAFLD) is becoming an important public health concern globally. It is associated with cardiovascular disease, type 2 diabetes, and cancers. In the US, it is the third leading cause of cirrhosis and second most common indication for liver transplant (first in women). Global prevalence of NAFLD is about 25% with a significant recent increase in emerging economies, and in the Middle East the presence of NAFLD may be as high as 70% in patients with type 2 diabetes. Unfortunately, a significant number of patients with NAFLD go on to develop non-alcoholic steatohepatitis (NASH) which is much more common in patients with type 2 diabetes. About 20% of the US population have NAFLD without associated diabetes. However, 33-66% of patients with type 2 diabetes have NAFLD. Other risk factors associated with NAFLD include obesity, age, gender, dyslipidemia, metabolic syndrome, and polycystic ovarian syndrome.

Methods

There are many ways to image NAFLD and NASH, including abdominal ultrasound, CT scan, and MRI or MR spectroscopy. More recently, elastography performed with ultrasound or MR has gained traction in diagnosing different stages of NAFLD and NASH. In this chapter, we plan to review some of the challenges in increasing global prevalence and early diagnostic methods to evaluate NAFLD.

Results

Unfortunately, NAFLD and NASH is increasing in prevalence globally and is becoming the leading cause of end-stage liver failure. Newer imaging methods are becoming more popular in screening and managing patients with NAFLD and NASH. A significant number of patients with NASH will go on to develop cirrhosis, which may result in hepatocellular carcinoma. Thus, early detection and management of NAFLD is critical. Percutaneous liver biopsy is no longer considered the gold standard for diagnosing NAFLD/NASH because of the small sample size, sampling error and complications related to the invasive nature of the procedure. Newer imaging technologies like MR elastography and other associated biochemical markers are noninvasive and reasonably accurate in diagnosing NAFLD.

Conclusions

Studies have shown that in people with extremely high BMI, bariatric surgery helps not only with type 2 diabetes but also in advanced stages of NASH, with a significant reversal of liver function test. Many type 2 diabetes medications like GLP analogs, SGLT2 inhibitors, alone or in combination, have been shown to significantly reduce the liver fat and further progression of NAFLD and NASH. Many attempts are being made to look at other targets like anti-CD3 and dual GLP-GIP agonists are being evaluated for treatment of early stages of NAFLD.

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Prevention and pharmacological interventions in NAFLD/NASH

Session Type
PARALLEL SESSION
Date
22.02.2020, Saturday
Session Time
08:30 - 10:00
Channel
Paris
Lecture Time
08:55 - 09:20

Abstract

Background and Aims

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease defined by intrahepatic lipid accumulation which is strongly associated with insulin resistance (IR) and inceases the risk for type 2 diabetes mellitus (T2DM) two- to threefold. Conversely, persons with T2DM have a higher prevalence of steatohepatitis, liver fibrosis and end-stage liver disease. Prevalence and incidence of NAFLD are dramatically increasing and NAFLD is projected to be the most common cause of chronic liver disease. In addition, NAFLD independently contributes to cardiovascular disease. CVD is the most common cause of death in patients with NAFLD. Therefore, early screening and identification of NAFLD is needed. Given the high prevalence and the rising incidence of NAFLD, and its clinical importance, the absence of approved therapies is striking.

Methods

Systematic review

Results

Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy. NAFLD therapies target 4 main pathways. The first approach is targeting hepatic fat accumulation via PPAR agonists (eg, pioglitazone), medications targeting the bile acid-farnesoid X receptor axis (obeticholic acid), inhibitors of de novo lipogenesis, GLP-1 receptor agonists (lira- and dulaglutide), dual GLP-1/GIP receptor agonist (tirzepatide), and fibroblast growth factor (FGF)-21 analogues. A second approach is targeting the oxidative stress, inflammation and injury via use of antioxidants (vitamin E), medications with a target in the TNF α pathway, and immune modulators (eg. cenicriviroc). A third group has a target in the gut, including antiobesity agents. Finally, antifibrotics are tested.

Conclusions

In the next few years several medications may become available to treat patients with NAFLD across the entire spectrum of disease, although their long-term safety and efficacy remain to be established.

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The global burden of NAFLD and NASH

Session Type
PARALLEL SESSION
Date
22.02.2020, Saturday
Session Time
08:30 - 10:00
Channel
Paris
Lecture Time
09:20 - 09:45

Q and A

Session Type
PARALLEL SESSION
Date
22.02.2020, Saturday
Session Time
08:30 - 10:00
Channel
Paris
Lecture Time
09:45 - 10:00