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World Gastroenterology Organisation Global GuidelinesNonalcoholic Fatty Liver Disease and Nonalcoholic SteatohepatitisReview Team, Douglas R. LaBrecque, MD, FACP (chair, USA),Zaigham Abbas, MD, MBBS, FCPS, FRCP, FRCPI, FACP, FACG, AGAF(Pakistan), Frank Anania, MD, FACP, AGAF (USA),Peter Ferenci, MD (Austria), Aamir G. Khan, MD (Pakistan),Khean-Lee Goh, MBBS, FRCP (Glasgow, London), MD, FACG, FASGE(Malaysia), Saeed S. Hamid, MD (Pakistan),Vasily Isakov, MD, PhD, AGAF (Russia), Maribel Lizarzabal, MD, PhD(Venezuela), Manuel M. Pen˜aranda, MD (Colombia), Juan F.R. Ramos,MD (Mexico), Shiv Sarin, MD, DM (India), Davor Stimac, MD (Croatia),Alan B.R. Thomson, MD (Canada), Muhammed Umar, MD, MBBS, MCPS,FCPS (PAK), FACG (USA), FRCP (L), FRCP (G), ASGE-M (USA),AGAF (USA) (Pakistan), Justus Krabshuis, (France),and Anton LeMair, MD (Netherlands)INTRODUCTIONOver the past couple of decades, it has becomeincreasingly clear that nonalcoholic fatty liver disease(NAFLD) and nonalcoholic steatohepatitis (NASH) arenow the number 1 cause of liver disease in the westerncountries. The prevalence of NAFLD has doubled duringlast 20 years, whereas the prevalence of other chronic liverdiseases has remained stable or even decreased. More recentdata conf i rm that NAFLD and NASH play an equallyimportant role in the Middle East, Far East, Africa, theCaribbean, and Latin America.NAFLD is a condition def i ned by excessive fat accu-mulation in the form of triglycerides (steatosis) in the liver. Asubgroup of NAFLD patients displays liver cell injury andinf l ammation in addition to excessive fat (steatohepatitis).The latter condition, designated NASH, is virtually indis-tinguishable histologically from alcoholic steatohepatitis.While the simple steatosis of NAFLD does not correlate withincreased short-term morbidity or mortality, progression ofthis condition to that of NASH dramatically increases therisks of cirrhosis, liver failure, and hepatocellular carcinoma.The exact cause of NASH has not been elucidated, andit is almost certainly not the same in every patient.Although it is most closely related to insulin resistance,obesity, and the metabolic syndrome, not all patients withthese conditions have NAFLD/NASH, and not all patientswith NAFLD/NASH suf f er from one of these conditions.NASH is a potentially fatal condition, leading to cirrhosis,liver failure, and hepatocellular carcinoma.There is no established therapy and there are no evidence-based clinical guidelines. There have not been any adequateprospective, double-blind, controlled trials to provide the datanecessary to create an evidence-based guideline. This GlobalGuideline is intended to provide the best opinions of a groupof experts from all areas of the globe concerning every aspectof this problem and the best approaches to diagnosing andtreating this condition, taking locally available resources intoaccount.Cascades: A Resource-sensitive ApproachA gold-standard approach is feasible for regions andcountries in which the full scale of diagnostic testsand medical treatment options are available for the man-agement of NASH. However, such resources are notavailable throughout much of the world. With theirFrom the Carver College of Medicine, University of Iowa, Iowa City,IA.The authors declare that they have nothing to disclose.Reprints: Douglas R. LaBrecque, MD, FACP, Department of InternalMedicine, Liver Service, University of Iowa Hospital and Clinics,200 Hawkins Drive, Iowa City, IA 52242 (e-mail: douglas-labrecque@uiowa.edu).Copyright r 2014 by Lippincott Williams & WilkinsWGO G UIDELINEJ Clin Gastroenterol ? Volume 48, Number 6, July 2014 www.jcge.com | 467guide.medlive.cn