1006 Non-Alcoholic Fatty Liver Disease Is an Increasing Reason for Referral to Gastroenterology

Abstract

INTRODUCTION: Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in prevalence. In integrated healthcare systems with limited clinic access, prior studies have utilized care pathways to triage patients to clinic in situations of suspected advanced fibrosis. Our aim was to study clinic utilization for NAFLD over time and assess how many patients could avoid specialty care using predictive scores such as the FIB4 and NAFLD fibrosis score (NFS). METHODS: Consecutive consultations to GI, 200 from 2012 and 300 from 2017, at a large Veterans Administration Hospital in Texas were retrospectively reviewed to determine reason for consultation, final diagnosis, additional workup, and follow up utilization. Weight 1 year after consultation was compared to the initial weight. Chi square testing and Student’s t test were used to compare categorical and quantitative data, respectively, using R. RESULTS: Among the 500 patients, the mean age was 57.4 years (+/- 13.9), 86.2% were male and 18.4% Hispanic. Of the 200 consults in 2012, 18 (9.0%) were for NAFLD compared to 53 (17.7%) of 300 consults from 2017 (P < 0.01). Comparatively, the number of consultations for Hepatitis C was not significantly different from 2012 to 2017 (19.5% vs. 16.7%, P = 0.42). Neither liver biopsy (27.8% vs. 17.0%, P = 0.32) nor MR elastography (11.1% vs. 28.9%, P = 0.20) use was significantly different between 2012 and 2017. Using the FIB4 score, 31 (43.7%) were classified as low risk and 11 (15.5%) were classified as high risk for advanced fibrosis. Using the NFS, 18 (25.4%) were classified as both low and high risk. 27 patients underwent MR elastography or liver biopsy and 13 (48%) were found to have advanced fibrosis. The performance characteristics of NFS and FIB4 compared to results of liver biopsy or MR elastography is presented in Table 1 and 2, respectively. Mean weight change 1 year later was -0.8% (+/-4.7%). There was no difference in weight change between those found to have advanced fibrosis or not (-0.3% [95%CI: -3.0- 2.3%] vs. -2.0% [95%CI:-4.1- 0.1], P = 0.29). CONCLUSION:: One of every 6 consultations to gastroenterology is for NAFLD, now exceeding Hepatitis C referrals in 2017. Using the NFS could save 25% of these referrals without missing cases of advanced fibrosis. GI care was not associated with weight loss. Prospective studies are needed to determine the efficacy of these strategies to triage NAFLD patients for specialty care.