| In 2014, the Japanese NAFLD/NASH guidelines were established. In this guidelines, NAFLD was characterized by evidence of hepatic steatosis by either imaging or histology and the appropriate exclusion of other liver diseases. NAFLD is histologically characterized by macrovesicular steatosis and further categorized into NAFL and NASH. NAFL is a mostly benign, while NASH can progress to cirrhosis or even HCC. Several regimens have been investigated for their effectiveness in treating NAFLD, including lifestyle interventions, surgical treatments, and pharmacotherapy. Recently several studies have shown that the hepatic fibrosis grade is the most important factor for the survival of NAFLD patients. In addition, NAFL and NASH are not completely different diseases, and they converse with each other. Imaging methods relevant to these conditions have rapidly progressed. And many reports have evaluated the various pharmaceutical regimens. In 2020, new guideline committee revised the NAFLD/NASH guidelines. The importance of hepatic fibrosis will be added to the definition and new screening and follow-up systems in NAFLD patients will be described. In this system, the FIB4 index or NAFLD fibrosis score is determined at first screening. If this score has increased, elastography is recommended. If the NAFLD patient has advanced hepatic fibrosis, then either liver biopsy, drug therapy or HCC screening is recommended. In terms of the treatment of NASH patients, SGLT2 inhibitors and GLP-1 analogues will be added as new candidates. In this symposium, I will introduce these and want to discuss. |
