Recomendaciones para la detección, diagnóstico y seguimiento de los pacientes con enfermedad por hígado graso no alcohólico en atención primaria y hospitalaria / Recommendations for the detection, diagnosis and follow-up of patients with non-alcoholic fatty liver disease in primary and hospital care

La enfermedad por hígado graso no alcohólico (EHGNA) es una de las enfermedades hepáticas crónicas más frecuentes, con una prevalencia del 20-30% en la población general y del 60-80% en poblaciones de riesgo. En un porcentaje no despreciable de pacientes la EHGNA progresa desde la esteatosis hacia a diferentes estadios de fibrosis y cirrosis. Por su alta prevalencia, la EHGNA se ha convertido en un problema de salud relevante que requiere de acciones específicas para su detección, diagnóstico, seguimiento y tratamiento. Además, dado que la EHGNA presenta un riesgo aumentado de morbimortalidad cardiovascular requiere un enfoque multidisciplinar para su tratamiento y seguimiento. Los pacientes en estadios iniciales de la enfermedad, sin fibrosis, pueden ser evaluados y recibir tratamiento en el ámbito de Atención Primaria, mientras que aquellos con enfermedad hepática avanzada se benefician de un seguimiento especializado en el ámbito hospitalario para prevenir y tratar las complicaciones hepáticas. El presente documento de consenso, elaborado por las Sociedades Catalanas de Digestología, Atención Primaria, Endocrinología, Diabetes y Medicina Interna nace de la necesidad de diseñar estrategias que guíen los flujos de los pacientes entre el ámbito de Atención Primaria y Hospitalaria para poder ofrecer a los pacientes con EHGNA la mejor atención según el estadio de su enfermedad. En el documento de consenso se describen los métodos diagnósticos no invasivos más utilizados para el diagnóstico de los pacientes y se han diseñado dos algoritmos para el tratamiento de los pacientes tanto en ámbito de atención primaria como de atención hospitalaria

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care

Recommendations for the detection, diagnosis and follow-up of patients with non-alcoholic fatty liver disease in primary and hospital care. / Recomendaciones para la detección, diagnóstico y seguimiento de los pacientes con enfermedad por hígado graso no alcohólico en atención primaria y hospitalaria.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care.

Colangitis biliar primaria en España. Resultados de un estudio Delphi sobre su epidemiología, diagnóstico, seguimiento y tratamiento / Primary biliary cholangitis in Spain. Results of a Delphi study of epidemiology, diagnosis, follow-up and treatment

Introducción: la colangitis biliar primaria (CBP) es una enfermedad rara, de la que existe información limitada en España sobre su epidemiología y manejo en la práctica clínica habitual. Objetivos: conocer la epidemiología, flujo del paciente, diagnóstico, seguimiento y tratamiento de la CBP en España. Métodos: revisión de la literatura y estudio siguiendo la metodología Delphi con participación de 28 especialistas en dos rondas de consulta y un taller de validación de resultados presencial. Resultados: existen, aproximadamente, 9.400 pacientes con CBP en España, con una incidencia anual de entre 0,51 y 3,86 casos/100.000 habitantes, aunque el margen de error se presupone alto dada la escasez de estudios. El intervalo entre sospecha y confirmación diagnóstica puede ser de varios meses, realizándola mayoritariamente un gastroenterólogo o hepatólogo. El papel de la biopsia hepática en el diagnóstico y seguimiento es heterogéneo. El 95% de los pacientes son tratados con ácido ursodesoxicólico (AUDC) y la respuesta se monitoriza mayoritariamente utilizando el criterio de Barcelona. El seguimiento es semestral, con un uso heterogéneo de las diferentes técnicas disponibles. No existen recomendaciones ni fármacos comercializados en segunda línea en caso de no respuesta, respuesta insuficiente o intolerancia al tratamiento con AUDC. Conclusiones: aunque es posible estimar la epidemiología a partir de la opinión de expertos, se necesitan registros nacionales que aporten información precisa y actualizada sobre la epidemiología, el estadio y la respuesta al tratamiento de los pacientes con CBP, así como tratamientos nuevos para ciertos grupos de pacientes

Introduction: primary biliary cholangitis (PBC) is a rare disease with limited data regarding its epidemiology and standard clinical management in Spain. Objective: to gain insight into the epidemiology, patient flow, diagnosis, follow-up and treatment of PBC in Spain. Methods: a review of the literature and Delphi study involving 28 specialists in two rounds of consultations and an in-person results validation workshop. Results: there are approximately 9,400 patients with PBC in Spain, with an annual incidence of 0.51-3.86 cases/100,000 population. Albeit, a high error margin may be presumed due to the scarcity of relevant studies on this subject. Several months may elapse from suspicion to a confirmed diagnosis, usually by a gastroenterologist or hepatologist. The role of the liver biopsy for diagnosis and follow-up is heterogeneous. Overall, 95% of patients are treated with ursodeoxycholic acid (UDCA) and response is primarily monitored using the Barcelona criteria. Follow-up is performed every six months, with a heterogeneous use of the various available techniques. No recommendations or second-line commercial drugs are available in the case of no response, inadequate response or intolerance to UDCA. Conclusions: while epidemiology may be estimated based on expert opinions, national registries are needed to provide accurate, up-to-date information on epidemiological parameters, disease stage and response to treatment in patients with PBC. Furthermore, novel therapies are required for selected patient groups

Primary biliary cholangitis in Spain. Results of a Delphi study of epidemiology, diagnosis, follow-up and treatment.

INTRODUCTION: primary biliary cholangitis (PBC) is a rare disease with limited data regarding its epidemiology and standard clinical management in Spain. OBJECTIVE: to gain insight into the epidemiology, patient flow, diagnosis, follow-up and treatment of PBC in Spain. METHODS: a review of the literature and Delphi study involving 28 specialists in two rounds of consultations and an in-person results validation workshop. RESULTS: there are approximately 9,400 patients with PBC in Spain, with an annual incidence of 0.51-3.86 cases/100,000 population. Albeit, a high error margin may be presumed due to the scarcity of relevant studies on this subject. Several months may elapse from suspicion to a confirmed diagnosis, usually by a gastroenterologist or hepatologist. The role of the liver biopsy for diagnosis and follow-up is heterogeneous. Overall, 95% of patients are treated with ursodeoxycholic acid (UDCA) and response is primarily monitored using the Barcelona criteria. Follow-up is performed every six months, with a heterogeneous use of the various available techniques. No recommendations or second-line commercial drugs are available in the case of no response, inadequate response or intolerance to UDCA. CONCLUSIONS: while epidemiology may be estimated based on expert opinions, national registries are needed to provide accurate, up-to-date information on epidemiological parameters, disease stage and response to treatment in patients with PBC. Furthermore, novel therapies are required for selected patient groups.

Hospital admission is a relevant source of hepatitis C virus acquisition in Spain.

BACKGROUND/AIMS: Isolated cases of acute hepatitis C, as well as hepatitis C outbreaks transmitted by health-care related procedures, have drawn attention to nosocomial transmission of HCV. The aim of this study was to investigate the current relevance of nosocomial HCV infection. METHODS: For this purpose, we performed a retrospective epidemiological analysis of all cases of acute hepatitis C diagnosed in 18 Spanish hospitals. Between 1998 and 2005, 109 cases were documented. RESULTS: The most relevant risk factors registered during the 6-month period preceding the diagnosis of acute hepatitis C were: hospital admission in 73 (67%) cases, intravenous drug use in 9 (8%), accidental needlestick injury in 7 (6%) and sexual contact in 6 (5%). Among the 73 patients in whom hospital admission was the only risk factor, 33 underwent surgery and 24 were admitted to a medical emergency unit or a medical ward; the remaining 16 patients underwent an invasive diagnostic or therapeutic procedure. Sixty two patients underwent antiviral therapy and 51 (82%) achieved a sustained virological response. In 47 patients treatment was not indicated (in 24 due to spontaneous resolution of HCV infection). CONCLUSIONS: In most patients with acute hepatitis C the only documented risk factor associated with the infection is hospital admission. These results stress the need for strict adherence to universal precaution measures. Fortunately, most cases of acute hepatitis C either resolve spontaneously or after antiviral therapy.