Nonalcoholic Fatty Liver Disease in Children: a Modern View on the Diagnosis and Treatment (II Part)

Y.M. Stepanov, A.Ye. Abaturov, N.Y. Zavgorodnya, I.Yu. Skirda

Abstract


In Part II methods of research and treatment of nonalcoholic fatty liver disease in children are highlighted, which are based on the evidence. Ultrasound examination of the liver is the most common method for diagnosis of nonalcoholic fatty liver disease in children and adults due to the safety, availability and relatively low cost. The sensitivity of this method in the detection of mild and severe hepatic steatosis in children is 79.7 %, specificity — 86.2 %. But high correlation with histological studies is observed only in cases of fatty degeneration in more than 20 % of the hepatocytes.
At present, a biopsy is the only way to verify the diagnosis of nonalcoholic fatty liver disease and the gold standard for determining the extent of liver tissue damage, histological inflammatory activity and fibrosis.
The main goal of treating nonalcoholic fatty liver disease is to prevent the development of the terminal stages of the disease. The main areas of medical intervention are the correction of metabolic disorders, restoration of insulin sensitivity and liver protection.
The rapid increase in the prevalence along with the progressive course of nonalcoholic fatty liver disease with the possibility of the formation of liver cirrhosis and hepatocellular carcinoma require a prompt diagnosis of this disease in children. In the absence of specific symptoms of nonalcoholic fatty liver disease diagnostic scree-ning ought to be performed in children with risk factors. Obesity is the leading indication for diagnostic search of nonalcoholic fatty liver disease in children. Identification of genetic predictors of nonalcoholic fatty liver disease allows distinguish a group of patients who require active monitoring because of the disease progression pro-bability. Diagnosis of nonalcoholic fatty liver disease is possible after careful exclusion of other steatosis’ causes based on the age of the child and relevant clinical and laboratory data. Imaging techniques allow detect and quantify the minimum degree of steatosis, but a liver biopsy remains the gold standard for determining the extent of liver tissue damage and fibrosis. Modification of the lifestyle is the first line treatment for nonalcoholic fatty liver disease in children. Drug correction using insulin sensitizing agents, hepatoprotectors, antioxidants, pre- and probiotics are administered in cases of ineffectiveness of the first-line therapy.


Keywords


non-alcoholic fatty liver disease; steatosis; children

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DOI: https://doi.org/10.22141/2308-2097.3.57.2015.81535

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