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Pediatric gastroenterology evaluation of children with suspected NALFD

This month's Alimentary Pharmacology & Therapeutics reports on the pediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease.

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Screening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies.

However, gastroenterology societies have called for more data before making a formal recommendation.

Dr Schwimmer and colleagues from California, USA determined whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to pediatric gastroenterology resulted in a correct diagnosis of NAFLD.

Information generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care, and referral to pediatric gastroenterology was captured prospectively.

The research team reported diagnostic outcomes.

Advanced fibrosis was present in 11% of children
Alimentary Pharmacology & Therapeutics

The diagnostic performance of 2 times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed.

The researchers found that non-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral.

Liver disease other than NAFLD was present in 18% of those referred.

The team observed that autoimmune hepatitis was the most common alternative diagnosis.

The researchers found that children with NAFLD had significantly higher screening ALT than children with liver disease other than NAFLD.

Advanced fibrosis was present in 11% of children.

The team noted that for the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%.

Dr Schwimmer's team concludes, "Screening of overweight and obese children in primary care for NAFLD with referral to pediatric gastroenterology has the potential to identify clinically relevant liver pathology."

"Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner."

Aliment Pharmacol Ther 2013: 38(10): 1267–1277
06 November 2013

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