Editorial

Yanette Suárez Quintero, MD. (1)

(1) Internist, gastroenterologist and hepatologist. MsC in Pharmacoeconomics. Hospital Universitario San Ignacio, Gastroenterology Unit.        Pontificia Universidad Javeriana. Bogotá, Colombia.

Received:     27-05-14    Accepted:    03-04-14

Nonalcoholic fatty liver disease (NALFD) is characterized by an accumulation of fat exceeding the 5% to 10% of the liver's weight. The disease's spectrum extends to including the presence of inflammation and/or fibrosis which is called nonalcoholic steatohepatitis (NASH) and may even include cirrhosis. The prevalence of NAFLD ranges from 25% to 30% in Western countries. In the United States, where 25% of the population is obese, two thirds of the obese portion of the population may have NALFD which reaches a prevalence of 90% in the case of type III obesity. Similarly, it has been estimated that 2% to 3% of the population may have NASH. Unfortunately we do not have our own statistics for Colombia which has meant that scenarios for our country have been extrapolated from the epidemiology of the United States.

We know that the number of patients being evaluated for the possible diagnoses of NALFD is high in Colombia, so high that compulsory comprehensive evaluations have become institutionalized. In part this can be explained by the fact that NALFD is now considered to be the hepatic component of metabolic syndrome. Nevertheless, we all know that this is not the only scenario in which NAFLD is present, and that it may be the manifestation of some more complex liver disease, or it may be an incidental finding with no significant impact on patient health.

Assessment of a patient for NALFD, like assessments for other diseases with increasing incidences, must take into account the epidemiological background of each patient, and, although it is obviously important when there is risk of metabolic disease and progression to cirrhosis, assessment must also consider whether or not resource use is excessive when it is done for patients for whom an in-depth study of NALFD will not change morbidity or mortality. False expectations can be raised when a patient comes to expect that testing for this disease is going to solve her or his symptoms even if they have nothing to do with NALFD. We have many diagnostic and prognostic tools today that allow us to place the patient in the proper context and make an assessment of the cost-effectiveness of NAFLD testing for each patient. In this way we can use our resources equitably without irrational and disproportionate spending yet without depriving high risk patients who are at high risk of progression to chronic liver disease. It is our responsibility to use these resources judiciously and to properly explain the patient's disease in a way that clarifies doubts and fears that may arise.