Expert Opinion on the Management of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Middle East with a Focus on the Use of Silymarin

Ahmed Hashem,Malfi Al Otaibi,Anton Gillessen,Hussam Saleh,Saleh Ahmed,Reyaz Ahmad,Mohamed Guda,Elwin Buchel,Fateh Al Idris,Hamouda Ahmed,Yogesh Shastri

doi:10.3390/gastroent12020014

Abstract

Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease in the world [1,2,3,4]. It includes a histological continuum of non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), which can be differentiated by liver biopsy [2,3]
There are not many studies evaluating the prevalence of NAFLD in the region, available data suggest that the prevalence of NAFLD in the Middle East countries (32%) is similar to worldwide incidence, with impactful consequence and disease burden [1]
The prevalence of NAFLD in Kuwait, South of Iran, and North of Iran was 33.3%, 21.5%, and 43.8%, respectively [28,29], whereas a recent study conducted in 2018 indicated the prevalence to be estimated at 25% in both Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE)

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease in the world [1,2,3,4]. It includes a histological continuum of non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), which can be differentiated by liver biopsy [2,3]. NASH is associated with increased liver-related mortality and hepatocellular carcinoma, even in the absence of cirrhosis, and is predicted to become a rising indication for liver transplantation by 2020 [2,10,11,12,13,14]

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