HEPAMAP: A Roadmap For Hepatology Research In Europe: An
Research from EASL and other liver organizations reveals that up to 44% of these people are likely to suffer from non-alcoholic fatty liver disease (NAFLD).
Non-alcoholic steatohepatitis (NASH): Definition natural history and
3 déc. 2018 A roadmap for hepatology research in Europe: An overview for policy makers. EASL 2015. 3% NASH. (EU: ~10 M). 1974 mean BMI ?.
EASL ANNUAL REPORT 2014
EASL now undertakes considerable efforts to work with the Commission and European Parliament not only to place greater emphasis on liver disease research.
EASLs response to the European Commission call for evidence on
17 févr. 2022 Mortality from liver cancer has increased in most European ... Liver (EASL) and European Organisation for Research and Treatment of Cancer.
European Association for the Study of the Liver – Annual Report 2016
EASL is a medical association driven by Governing Board members dedicated to pursuing excellence in liver research clinical practice of liver disorders
Year of the Nurse
liver research clinical practice of liver disorders
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23 juin 2022 EASL is a medical association dedicated to pursuing excellence in liver research clinical practice of liver disorders
European Reference Network (ERN) RARE- LIVER
16 avr. 2019 The European Commission and the Agency do not accept any ... EASL Clinical Practice Guidelines on nutrition in chronic liver disease .
50 years of EASL – From a European to a global perspective
launch of HEPAMAP just last month in the European Parliament in Brussels. We presented the roadmap for liver disease research in Europe to our policy makers
ERN-RARE-LIVER
27 sept. 2017 ERN-RARE-LIVER. European Reference Networks (HP-ERN-SGA). Specific Grant Agreement 769048. D4.3: Survey of guidelines including plan for ...
HEPAMAP - easleu
ROADMAP FOR HEPATOLOGY RESEARCH IN EUROPE: AN OVERVIEW FOR POLICY MAKERS Hepamap includes the following subject areas: EASL has taken steps to accompany Hepamap with a number of collaborative approaches: 1) Viral hepatitis: basic science 2) Viral hepatitis: clinical / translational 3) Alcoholic Liver Disease and Non-Alcoholic Liver Disease
About EASL - EASL-The Home of Hepatology
EASL the European Association for the Study of the Liver founded in 1966 is a medical association dedicated to pursuing excellence in liver research to the clinical practice of liver disorders and to providing education to all those interested in hepatology As of 2021 EASL serves more than 4200 members
THE INTERNATIONAL LIVER CONGRESS™ VIENNA AUSTRIA 10-14
interested in hepatology Whilst the roots of the association were founded in Europe in 1966 EASL continues to engage globally with all stakeholders in the liver field wherever they are based Our aim is to spread knowledge expertise and best practice as well as the latest scientific breakthroughs in hepatology and the International Liver
Searches related to a roadmap for hepatology research in europe easl filetype:pdf
The European Association for the Study of the Liver (EASL): Promoting liver research and education across Europe since 1966 EASL is Europe’s foremost organisation dedicated to advancing scientific medical and public understanding of the liver and liver disease Since its foundation in 1966 EASL has established itself as a
How has HCV-related liver disease changed clinical care?
- Clinical care for patients with HCV-related liver disease has advanced considerably during the last couple of decades, thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and radical improvements in therapy and pre- vention.
What are the EASL-Aleh clinical practice guidelines?
- EASL-ALEH Clinical Practice Guidelines: non- invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63:237–264.
How is cirrhosis assessed in patients with chronic hepatitis C?
- Patients with cirrhosis need to be assessed for portal hypertension, including oesophageal varices. In chronic hepatitis C, non-invasive methods should be used instead of liver biopsy to assess liver disease severity prior to therapy.
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Non-alcoholic steatohepatitis (NASH):
Definition
, natural history and current therapeutic interventionsFrank Tacke
University Hospital Aachen, Germany
EMA Workshop on Liver Diseases
London, Dec 3rd, 2018
Disclosures Frank Tacke
•Research support (materials, funding):Tobira/Allergan, Galapagos, Inventiva, BMS
•Speaker/Consulting:Tobira/Allergan, Gilead, AbbVie, BMS, Falk,
Boehringer, Galapagos, Intercept, Inventiva
Non-alcoholic Fatty Liver Disease:
The epidemiological challenge
Total population 20 30% NAFLD (EU: ~116 M) 0.2%-0.5% HCC (EU 200,000 -
500,000
HEPAMAP. A roadmap for hepatology research in Europe: An overview for policy makers. EASL 20153% NASH
(EU: ~10 M) 1974m
BMI (kg/m²)
NCD Risk Factor Collaboration, Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698
population-based measurement studies with 19·2 million participants. Lancet. 2016; 387(10026):1377-96 105 millions BMI>30 641 millions BMI>30
Non-alcoholic Fatty Liver Disease:
The epidemiological challenge
Total population 20 30% NAFLD (EU: ~116 M) 0.2%-0.5% HCC (EU 200,000 -
500,000
HEPAMAP. A roadmap for hepatology research in Europe: An overview for policy makers. EASL 20153% NASH
(EU: ~10 M)Projection for Germany
NAFLD NASH 20162030
NASH + 42% NASH-
Zirrhose
x 2.5Estes C, et al. J Hepatol. 2018; 69(4):896-904
18.4 15.9 1.2 0.7 0.4 0.2 0.0 5.0 10.0 15.0 20.0 25.0TotalF0F1F2F3F4
Millions
20.917.0 1.6 1.1 0.8 0.5 0.0 5.0 10.0 15.0 20.0 25.0
TotalF0F1F2F3F4
Millions
Non-alcoholic Fatty Liver Disease:
The epidemiological challenge
Total population 20 30% NAFLD (EU: ~116 M)
0.2%-0.5% HCC
(EU 200,000 -500,000
HEPAMAP. A roadmap for hepatology research in Europe: An overview for policy makers. EASL 20153% NASH
(EU: ~10 M)Projection for UK
NAFLD NASH 20162030
NASH + 43% NASH-
Zirrhose
x 2Estes C, et al. J Hepatol. 2018; 69(4):896-904
14.1 12.1 0.9 0.5 0.3 0.2 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0TotalF0F1F2F3F4
Millions
16.9 13.8 1.2 0.8 0.6 0.4 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0TotalF0F1F2F3F4
Millions
Non-alcoholic Fatty Liver Disease:
The clinical challenge
•Old(er) age, high(er) body-mass index •Many comorbidities (diabetes, kidney, cardiovascular...) •Substantial proportion unaware of their liver condition •High(er) rate of malignanciesNon-alcoholic Fatty Liver Disease:
The clinical challenge
https://broadly.vice.comPCOS (Polycystic Ovary Syndrome)
Hypothyroidism
Colorectal cancer
Cardiovascular Disease
Type 2 Diabetes
Chronic Kidney Disease
OSAS (Sleep Apnea)
NAFLDOsteoporosis
Byrne CD & Targher G, J Hepatol 2015;
62: S47-S64
Extrahepatic complications of
non-alcoholic fatty liver diseaseManagement of fatty liver disease:
EASL multidisciplinary Clinical Practice Guideline EASL-EASD-EASO CPG NAFLD. J Hepatol 2016; 64:1388-402 •Chairs -EASL: Giulio Marchesini -EASD: Michael Roden -EASO: Roberto Vettor •Panel members-EASL: Christopher P Day, Jean-François Dufour, Ali Canbay, Valerio Nobili, Vlad Ratziu, Herbert Tilg
-EASO: Gema Frühbeck, Lisbeth Mathus-Vliegen •Reviewers -Elisabetta Bugianesi, Helena Cortez-Pinto, Stephen HarrisonNatural history of fatty liver disease:
Definitions of NAFLD, NAFL and NASH
*According to histological analysis or proton density fat fraction or >5.6% by proton MRS or quantitative fat/water-selective MRI;
NAFLD •Excessive hepatic fat accumulation with IR •Steatosis in >5% of hepatocytes* •Exclusion of secondary causes and AFLD NASH NAFL •Pure steatosis •Steatosis and mild lobular inflammationCirrhotic
F4 fibrosis Fibrotic
2 3 fibrosis Early
F0/F1 fibrosis
HCC Definitive diagnosis of NASH requires a liver biopsy EASL-EASD-EASO CPG NAFLD. J Hepatol 2016; 64:1388-402Diagnosis and staging of fatty liver disease:
Role of liver biopsy
*Should not be used for initial diagnosis •Liver biopsy is essential for the diagnosis of NASH -Clinical, biochemical or imaging measures cannot distinguish NASH from steatosis •NAFL encompasses -Steatosis alone plus ONE of lobular or portal inflammation OR ballooning •NASH requires -Steatosis AND -Lobular or portal inflammation AND -Ballooning •NAS scoring indicates disease severity*Recommendations
NASH has to be diagnosed by a liver biopsy showing steatosis, hepatocyte ballooning and lobular inflammation A 1Grade of evidence
Grade of recommendation
EASL-EASD-EASO CPG NAFLD. J Hepatol 2016; 64:1388-402Diagnosis and staging of fatty liver disease:
Role of liver biopsy
Courtesy of Dr. Thomas Ritz, Institute of Pathology, University Hospital Aachen normalNAFLD NASH
fibrosisNAFLD / NASH
NASH-fibrosis
cirrhosis HCC 0.25 3% /year 0.3-2.6% /year 0.04 0.3% /yearNatural history of fatty liver disease:
Estimated progression rates
NAFLD1240% NASH
~10% NASH-fibrosis (F3) 30-50% NASH-cirrhosis
PYF, patients years of follow-up
Mortality rate ratio = actual mortality versus expected mortality05101520253035404550
Stage 1Stage 2Stage 3Stage 4
All CauseLiver Related
DulaiPS, et al. Hepatology 2017; 65: 1557-1565.
Mortality rate by fibrosis stage
Mortality
rate per 1 000 PYF •Meta-analysis of 5 studies on fibrosis-related mortality •1,495 NAFLD patients with 17,452 patient years of follow-up05101520253035404550
Stage 1Stage 2Stage 3Stage 4
All CauseLiver Related
Mortality rate ratio by fibrosis stage
Mortality rate ratio
1.58 (1.19 -2.11) 2.52 (1.85-3.42) 3.48 (2.51-4.83) 6.40 (4.11 -9.95) 1.41 (0.17-11.95) 9.57 (1.67 -54.93) 16.69 (2.92 -95.36) 42.30 (3.51 -510.34)Fibrosis determines the prognosis of
non-alcoholic fatty liver disease Vilar-Gomez E, et al. Gastroenterology. 2018; 155(2):443-457. •458 NAFLD patients (bridging fibrosis, F3, n=159; Child A5 cirrhosis, n=222; Child A6 cirrhosis, n=77); 4 tertiary centers, mean follow-up 5.5 years •Deaths: n=37, Liver Transplant: n=37, decompensation: n=88, Liver Cancer (HCC): n=41, Cardiovascular events: n=14, non-liver cancer: n=30Fibrosis determines the prognosis of
non-alcoholic fatty liver disease Vilar-Gomez E, et al. Gastroenterology. 2018; 155(2):443-457.Fibrosis determines the prognosis of
non-alcoholic fatty liver disease •458 NAFLD patients (bridging fibrosis, F3, n=159; Child A5 cirrhosis, n=222; Child A6 cirrhosis, n=77); 4 tertiary centers, mean follow-up 5.5 years •Deaths: n=37, Liver Transplant: n=37, decompensation: n=88, Liver Cancer (HCC): n=41, Cardiovascular events: n=14, non liver cancer: n=30 Rinella ME, Sanyal AJ. Nat Rev Gastroenterol Hepatol. 2016; 13:196-205.Low-risk profile
BMI < 29.9
Age < 40 yrs
No T2DM or
metabolic syndrome featuresNoninvasive fibrosis estimation:
•FIB-4 < 1.30 •APRI < 0.5 •NFS < -1.455FibroScan < 5 kPa
Intermediate-risk profile
BMI > 29.9
Age > 40 yrs
Multiple features of the metabolic syndrome
Noninvasive fibrosis estimation:
•FIB-4 1.30-2.67 •APRI 0.5-1.5 •NFS -1.455-0.675FibroScan 6-11 kPa
High risk profileALT level > AST level
Platelets < 150,000
Noninvasive fibrosis estimation:
•FIB-4 > 2.67 •APRI > 1.5 •NFS > 0.675FibroScan > 11 kPa
Hepatic steatosis on imaging
± elevated serum ALT levels
Evaluate alcohol
consumption Confirm NAFLD Exclude alternateFollow and reassess as
risk factors evolve Consider liver biopsyConsider liver biopsy or
confirmatory testing for cirrhosis (eg, MRE)A potential
algorithm for risk assessment in non- alcoholic fatty liver diseaseLow-risk profile
BMI < 29.9
Age < 40 yrs
No T2DM or
metabolic syndrome featuresNoninvasive fibrosis estimation:
•FIB-4 < 1.30 •APRI < 0.5 •NFS < -1.455FibroScan < 5 kPa
Intermediate-risk profile
BMI > 29.9
Age > 40 yrs
Multiple features of the metabolic syndrome
Noninvasive fibrosis estimation:
•FIB-4 1.30-2.67 •APRI 0.5-1.5 •NFS -1.455-0.675FibroScan 6-11 kPa
High risk profileALT level > AST level
Platelets < 150,000
Noninvasive fibrosis estimation:
•FIB-4 > 2.67 •APRI > 1.5 •NFS > 0.675FibroScan > 11 kPa
Hepatic steatosis on imaging
± elevated serum ALT levels
Evaluate alcohol
consumption Confirm NAFLD Exclude alternateFollow and reassess as
risk factors evolve Consider liver biopsyConsider liver biopsy or
confirmatory testing for cirrhosis (eg, MRE)A potential
algorithm for risk assessment in non- alcoholic fatty liver diseaseEASL-Guideline 2016:
Recommendation for liver biopsy, if
NASH or fibrosis is suspected
Rinella ME, Sanyal AJ. Nat Rev Gastroenterol Hepatol. 2016; 13:196-205.NAFLD / NASH
NASH-fibrosis
cirrhosis HCC 0.25 3% /year 0.3-2.6% /year 0.04 0.3% /yearNatural history of fatty liver disease:
Estimated progression rates
NAFLD / NASH
NASH-fibrosis
cirrhosis HCC 0.25 3% /year 0.3-2.6% /year 0.04 0.3% /yearNatural history of fatty liver disease:
Progression and Regression
NAFLD / NASH
NASH-fibrosis
cirrhosis HCC 0.25 3% /year 0.3-2.6% /year 0.04 0.3% /yearProgression of fatty liver disease:
Relevance of cofactors and lifestyle
Diabetes
Obesity
Genetic
factors (PNPLA3, TM6SF2...) AgeAlcohol
Lifestyle
Coffee
Exercise
Mediterranean diet
Vegetables
Normal
Steatosis
NASHCirrhosis
-Weight reduction (nutrition,GLP1-agonists, bariatric surgery)
-Lifestyle changes -optimal diabetes therapy (metformin, GLP1-agonists etc.) NASH-Fibrosis
Current therapeutic strategies in non-alcoholic
fatty liver diseasePhysical
activityAerobic & Resistance activity
independently: -Reduce liver fat -NASH and fibrosis - little evidencequotesdbs_dbs30.pdfusesText_36[PDF] Site No 7 Eastgate Buildings, Christchurch St East - Frome Town
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