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DEVELOPING PRACTICE GUIDANCE AND RECOMMENDATIONS FOR THE MANAGEMENT OF NAFLD IN PRIMARY CARE: CONSENSUS RESULTS

Christos D Lionis 1, Sophia Papadakis 1, Marilena Anastasaki 1, Eftihis Aligizakis 2, Foteini Anastasiou 3, Sven Francque 4, Irini Gergianaki 1, Juan Mendive 5, Maria Marketou 1, Jean W.M. Muris 6, Spilios Manolakopoulos 7, Georgios Papatheodoridis 8, Rachel Pryke 9, DIMITRIOS SAMONAKIS 10, Emmanouil Symvoulakis 11, Ioanna Tsiligianni 11

Affiliations

1 University of Crete, Heraklion, Greece

2 Health Center of Kandanos, Chania, Crete, Greece

3 Clinic of Social and Family Medicine, School of Medicine, Heraklion, Crete, Greece

4 University Hospital Antwerp, Edegem, Belgium

5 European Society for Primary Care Gastroenterology (ESPCG), Sant Adrià de Besòs ( Barcelona), Spain

6 Maastricht University, Moorveld, Netherlands

7 Ippokratio, Agia Paraskevi, Greece

8 Univ. Medical School Hippokration Hospital - Academic Dept. of Gastroenterology, Univ. Medical Schoo, Athens, Greece

9 Redditch Worcestershire, Nutrition Champion Royal College of GPs, UK, United Kingdom

10 Clinic Pagni, Heraklion, Greece

11 Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece

Summary

AI Generated

An international expert panel developed 14 consensus-based practice recommendations for screening, diagnosis, referral and management of non-alcoholic fatty liver disease in European primary care using a modified Delphi process.

A panel of 15 experts from 6 countries representing family medicine, gastroenterology, hepatology, cardiology and public health participated in a two-round Delphi consensus process
14 of 15 initially drafted statements achieved consensus with high agreement exceeding 90 percent after discussion and modification during an eight-hour hybrid meeting
The approved recommendations cover NAFLD risk assessment, diagnosis, referral to specialists, management, treatment, surgical management and integrated care
The recommendations were developed to address insufficient attention to NAFLD in European primary care where a large proportion of cases go undiagnosed or receive late diagnosis
The work was funded by an unrestricted research grant from GILEAD Sciences Inc to the University of Crete

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

In spite of its high prevalence and impact on health, non-alcoholic fatty liver disease (NAFLD) is not sufficiently addressed in European primary care (PC), with a large proportion of cases going undiagnosed or receiving late diagnosis. An international project was developed to design and evaluate an integrated, multidisciplinary, patient-centered model for NAFLD screening, diagnosis and linkage to specialty care and translate learnings into PC practice guidance.

Aims & Methods

Based on learning from this project, latest research evidence and existing guidelines for the management of NAFLD, we sought to develop a set of practice recommendations for screening, referral and management of NAFLD in PC.
The Rand/UCLA modified Delphi panel methods with 2 rounds was used to reach consensus on pre-defined statements. The international panel consisted of 15 experts from 6 countries, representing family medicine, gastroenterology, hepatology, cardiology and public health. Initially, 15 statements were drafted based on a synthesis of evidence from the literature and findings of this project. Prior to the consensus meeting, statements were rated by the experts in a first round. Subsequently, during a hybrid meeting of eight hours, experts discussed findings of round one, modified statements and rescored the updated recommendations in a second round.

Results

In round one, 10 of the 15 statements received high level of agreement (75% or greater). During the consensus process, 14 of 15 statements were considered appropriate and consensus was reached for all, with high agreement (>90%). The approved list included recommendations from several domains, including NAFLD risk assessment. diagnosis, referral to specialists, management, treatment, surgical management and integrated care.

Conclusion

The final set of 14 recommendations seeks to increase the comprehensive care for NAFLD in PC. We anticipate these recommendations to contribute to the ongoing discussion on systematic approaches to tackle NAFLD and support European PC providers through the integration of latest evidence into practice.

References

A relevant to the project publication:
Development and implementation of a continuing medical education program on non-alcoholic fatty liver disease for primary care practitioners in Europe. Papadakis S, Anastasaki M, Gergianaki I, Koek G, Mendive J, Anastasiou F, Heyens L, Garcia-Retortillo M, Muris J, Lionis C. Front Med (Lausanne). 2023 Mar 23;10:1034626. doi: 10.3389/fmed.2023.1034626. eCollection 2023. PMID: 37035308

Disclosure

It was based on a unrestricted research grant provided to the University of Crete by GILEAD Siences, Inc. after an open call.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Risk stratification in early squamous cell carcinoma and treatment options for Barrett’s recurrence

Alanna Ebigbo 1

Affiliations

1 St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany

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Summary is not available for this content yet.

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Oesophagus Endoscopy Digestive Oncology

Session

Scope it out: Endoscopic mastery in upper GI neoplasia

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

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UEG Podcast Episode

Journal Podcast

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UEG Journal Best Paper Award

Mohsan Subhani, Maria Manuela Estevinho, Malte Buchholz

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Abstract

Published

2025

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Emma V. Carrington 1

Affiliations

1 University of North Carolina / NCRBSI, London, United Kingdom

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Surgery Colorectal

Session

Strategies in proctology: From diagnosis to multidisciplinary management

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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2026

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Affiliations

1 University of North Carolina / NCRBSI, London, United Kingdom

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

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Session

Strategies in proctology: From diagnosis to multidisciplinary management

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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Unexplained anal pain

Frederic Ris 1

Affiliations

1 Geneva University Hospitals, Geneva, Switzerland

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Abstract

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Colorectal

Session

Black box problems in proctology

Citation

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The EoE clinical recipe: ingredients from cause to care (AstraZeneca) (Complete Session)

Evan S. Dellon 1, Luc Biedermann 2, Ulrike von Arnim 3, Francesca Racca 4, Alfredo J. Lucendo 5

Affiliations

1 University of North Carolina School of Medicine, Chapel Hill, NC, United States of America

2 USZ Zürich, Zurich, Switzerland

3 Otto-Von Guericke University, Madgeburg, Germany

4 Humanitas Gavazzeni e Castelli, None, Italy

5 Hospital General de Tomelloso, Madrid, Spain

Summary

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Abstract

Publisher

AstraZeneca

Event

UEG Week Barcelona 2026

Session

The EoE clinical recipe: ingredients from cause to care (AstraZeneca)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

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