{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:51:48Z","timestamp":1768823508884,"version":"3.49.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,10]],"date-time":"2022-07-10T00:00:00Z","timestamp":1657411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,10]],"date-time":"2022-07-10T00:00:00Z","timestamp":1657411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004191","name":"Novo Nordisk","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease, is underdiagnosed and expected to become the leading indication for liver transplant in the United States. We aimed to understand the medical journey of patients with NASH and role of hepatologists\/gastroenterologists in diagnosing and treating patients with NASH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A United States population-based cross-sectional online survey was completed by 226 healthcare professionals (HCPs) who treat patients with NASH and 152 patients with NASH; this study focuses on the patient and 75 hepatologist\/gastroenterologist HCP respondents. Tests of differences (chi square, t-tests) between respondent types were performed using SPSS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Most patients reported receiving their diagnosis of NASH from a hepatologist (37%) or gastroenterologist (26%). Hepatologists\/gastroenterologists were more likely than other HCPs to use FibroScan (transient elastography) to diagnose NASH and were more likely to distinguish between NASH with or without fibrosis. Hepatologists\/gastroenterologists (68%) and patients (52%) agree that hepatologists\/gastroenterologists are the primary coordinators of NASH care. The majority of hepatologists\/gastroenterologists (85%) are aware of American Association for the Study of Liver Diseases (AASLD) clinical practice guidance, and 86% of those aware consider them when diagnosing patients with NASH. Hepatologists\/gastroenterologists most frequently recommended exercise (86%), diet (70%), and supplements (58%) for ongoing management of NASH. Pharmaceutical medications for comorbidities were prescribed by a minority of hepatologists\/gastroenterologists for their patients with NASH. Hepatologists\/gastroenterologists cite difficulty (67%) or unwillingness (64%) to adhere to lifestyle changes as primary reasons patients with NASH discontinue NASH treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Hepatologists\/gastroenterologists are considered the coordinators of NASH care. While recognizing that patient adherence to lifestyle changes is the basis for successful treatment, important barriers limit successful implementation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-022-02410-x","type":"journal-article","created":{"date-parts":[[2022,7,10]],"date-time":"2022-07-10T12:02:28Z","timestamp":1657454548000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Nonalcoholic steatohepatitis medical patient journey from the perspective of hepatologists, gastroenterologists and patients: a cross-sectional survey"],"prefix":"10.1186","volume":"22","author":[{"given":"Mary","family":"Rinella","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna R.","family":"Cryer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Articolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Nadolsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,7,10]]},"reference":[{"issue":"1","key":"2410_CR1","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","volume":"67","author":"N Chalasani","year":"2018","unstructured":"Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328\u201357.","journal-title":"Hepatology"},{"issue":"2","key":"2410_CR2","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1053\/j.gastro.2018.04.034","volume":"155","author":"E Vilar-Gomez","year":"2018","unstructured":"Vilar-Gomez E, Calzadilla-Bertot L, Wai-Sun Wong V, Castellanos M, Aller-de la Fuente R, Metwally M, et al. Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease: a multi-national cohort study. Gastroenterology. 2018;155(2):443-57.e17.","journal-title":"Gastroenterology"},{"issue":"5","key":"2410_CR3","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1002\/hep.29085","volume":"65","author":"PS Dulai","year":"2017","unstructured":"Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65(5):1557\u201365.","journal-title":"Hepatology"},{"issue":"6","key":"2410_CR4","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1002\/hep.24268","volume":"53","author":"ZM Younossi","year":"2011","unstructured":"Younossi ZM, Stepanova M, Rafiq N, Makhlouf H, Younoszai Z, Agrawal R, et al. Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality. Hepatology. 2011;53(6):1874\u201382.","journal-title":"Hepatology"},{"issue":"5","key":"2410_CR5","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1002\/hep.27368","volume":"61","author":"M Ekstedt","year":"2015","unstructured":"Ekstedt M, Hagstr\u00f6m H, Nasr P, Fredrikson M, St\u00e5l P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547\u201354.","journal-title":"Hepatology"},{"issue":"2","key":"2410_CR6","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1053\/j.gastro.2015.04.043","volume":"149","author":"P Angulo","year":"2015","unstructured":"Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389-97.e10.","journal-title":"Gastroenterology"},{"issue":"1","key":"2410_CR7","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.jhep.2004.09.012","volume":"42","author":"LA Adams","year":"2005","unstructured":"Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol. 2005;42(1):132\u20138.","journal-title":"J Hepatol"},{"issue":"4","key":"2410_CR8","first-page":"820","volume":"40","author":"E Fassio","year":"2004","unstructured":"Fassio E, Alvarez E, Dom\u00ednguez N, Landeira G, Longo C. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology. 2004;40(4):820\u20136.","journal-title":"Hepatology"},{"issue":"7","key":"2410_CR9","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1136\/gut.2009.205088","volume":"59","author":"VW Wong","year":"2010","unstructured":"Wong VW, Wong GL, Choi PC, Chan AW, Li MK, Chan HY, et al. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010;59(7):969\u201374.","journal-title":"Gut"},{"issue":"1","key":"2410_CR10","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","volume":"64","author":"ZM Younossi","year":"2016","unstructured":"Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73\u201384.","journal-title":"Hepatology"},{"issue":"6","key":"2410_CR11","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1111\/liv.14828","volume":"41","author":"S Ciardullo","year":"2021","unstructured":"Ciardullo S, Perseghin G. Prevalence of NAFLD, MAFLD and associated advanced fibrosis in the contemporary United States population. Liver Int. 2021;41(6):1290\u20133.","journal-title":"Liver Int"},{"issue":"4","key":"2410_CR12","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jhep.2018.05.036","volume":"69","author":"C Estes","year":"2018","unstructured":"Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016\u20132030. J Hepatol. 2018;69(4):896\u2013904.","journal-title":"J Hepatol"},{"issue":"11","key":"2410_CR13","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1038\/s41395-018-0088-6","volume":"113","author":"M Noureddin","year":"2018","unstructured":"Noureddin M, Vipani A, Bresee C, Todo T, Kim IK, Alkhouri N, et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018;113(11):1649\u201359.","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"2410_CR14","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1007\/s00535-017-1415-1","volume":"53","author":"Y Sumida","year":"2018","unstructured":"Sumida Y, Yoneda M. Current and future pharmacological therapies for NAFLD\/NASH. J Gastroenterol. 2018;53(3):362\u201376.","journal-title":"J Gastroenterol"},{"issue":"12","key":"2410_CR15","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1001\/jama.2020.2298","volume":"323","author":"AC Sheka","year":"2020","unstructured":"Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA. 2020;323(12):1175\u201383.","journal-title":"JAMA"},{"issue":"27","key":"2410_CR16","first-page":"9026","volume":"20","author":"IL Nalbantoglu","year":"2014","unstructured":"Nalbantoglu IL, Brunt EM. Role of liver biopsy in nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20(27):9026\u201337.","journal-title":"World J Gastroenterol"},{"key":"2410_CR17","doi-asserted-by":"publisher","first-page":"S154","DOI":"10.1016\/j.jval.2019.04.632","volume":"22","author":"J Deemer","year":"2019","unstructured":"Deemer J, Heinz S. PDB84 liver biopsy\u2014a bottleneck to nash diagnosis. Value Health. 2019;22:S154.","journal-title":"Value Health"},{"issue":"3","key":"2410_CR18","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1053\/j.gastro.2021.04.074","volume":"161","author":"F Kanwal","year":"2021","unstructured":"Kanwal F, Shubrook JH, Younossi Z, Natarajan Y, Bugianesi E, Rinella ME, et al. Preparing for the NASH epidemic: a call to action. Gastroenterology. 2021;161(3):1030-42.e8.","journal-title":"Gastroenterology"},{"issue":"1","key":"2410_CR19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/cld.1045","volume":"17","author":"Y Ando","year":"2021","unstructured":"Ando Y, Jou JH. Nonalcoholic fatty liver disease and recent guideline updates. Clin Liver Dis. 2021;17(1):23\u20138.","journal-title":"Clin Liver Dis"},{"issue":"2","key":"2410_CR20","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.cgh.2017.09.041","volume":"16","author":"NE Rich","year":"2018","unstructured":"Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(2):198-210.e2.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"4","key":"2410_CR21","first-page":"242","volume":"7","author":"SA Hashemi","year":"2016","unstructured":"Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: a systematic review and meta-analysis. Caspian J Intern Med. 2016;7(4):242\u201352.","journal-title":"Caspian J Intern Med"},{"issue":"1","key":"2410_CR22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1177\/1756283X15611581","volume":"9","author":"ME Rinella","year":"2016","unstructured":"Rinella ME, Lominadze Z, Loomba R, Charlton M, Neuschwander-Tetri BA, Caldwell SH, et al. Practice patterns in NAFLD and NASH: real life differs from published guidelines. Therap Adv Gastroenterol. 2016;9(1):4\u201312.","journal-title":"Therap Adv Gastroenterol"},{"issue":"7","key":"2410_CR23","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1053\/j.gastro.2020.01.052","volume":"158","author":"TG Cotter","year":"2020","unstructured":"Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020: the state of the disease. Gastroenterology. 2020;158(7):1851\u201364.","journal-title":"Gastroenterology"},{"issue":"2","key":"2410_CR24","doi-asserted-by":"publisher","first-page":"275","DOI":"10.2337\/dci19-0064","volume":"43","author":"K Cusi","year":"2020","unstructured":"Cusi K. Time to include nonalcoholic steatohepatitis in the management of patients with type 2 diabetes. Diabetes Care. 2020;43(2):275.","journal-title":"Diabetes Care"},{"issue":"6","key":"2410_CR25","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/MAJ.0000000000000530","volume":"350","author":"CB Turer","year":"2015","unstructured":"Turer CB. Tools for successful weight management in primary care. Am J Med Sci. 2015;350(6):485\u201397.","journal-title":"Am J Med Sci"},{"issue":"2","key":"2410_CR26","doi-asserted-by":"publisher","first-page":"284","DOI":"10.2337\/dc09-0148","volume":"33","author":"E Hamaguchi","year":"2010","unstructured":"Hamaguchi E, Takamura T, Sakurai M, Mizukoshi E, Zen Y, Takeshita Y, et al. Histological course of nonalcoholic fatty liver disease in Japanese patients: tight glycemic control, rather than weight reduction, ameliorates liver fibrosis. Diabetes Care. 2010;33(2):284\u20136.","journal-title":"Diabetes Care"},{"issue":"4","key":"2410_CR27","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1002\/hep.30658","volume":"70","author":"A Do","year":"2019","unstructured":"Do A, Kuszewski EJ, Langberg KA, Mehal WZ. Incorporating weight loss medications into hepatology practice for nonalcoholic steatohepatitis. Hepatology. 2019;70(4):1443\u201356.","journal-title":"Hepatology"},{"issue":"2","key":"2410_CR28","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","volume":"149","author":"E Vilar-Gomez","year":"2015","unstructured":"Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-78.e5.","journal-title":"Gastroenterology"},{"issue":"4","key":"2410_CR29","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1053\/j.gastro.2020.06.006","volume":"159","author":"G Lassailly","year":"2020","unstructured":"Lassailly G, Caiazzo R, Ntandja-Wandji LC, Gnemmi V, Baud G, Verkindt H, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology. 2020;159(4):1290-301.e5.","journal-title":"Gastroenterology"},{"issue":"2","key":"2410_CR30","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1002\/hep.22009","volume":"47","author":"S Bellentani","year":"2008","unstructured":"Bellentani S, Dalle Grave R, Suppini A, Marchesini G. Fatty liver Italian N. behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology. 2008;47(2):746\u201354.","journal-title":"Hepatology"},{"issue":"7","key":"2410_CR31","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1097\/JOM.0b013e3181a86671","volume":"51","author":"ME Short","year":"2009","unstructured":"Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, et al. How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med. 2009;51(7):786\u201396.","journal-title":"J Occup Environ Med"},{"issue":"2","key":"2410_CR32","doi-asserted-by":"publisher","first-page":"100234","DOI":"10.1016\/j.jhepr.2021.100234","volume":"3","author":"JV Lazarus","year":"2021","unstructured":"Lazarus JV, Palayew A, Carrieri P, Ekstedt M, Marchesini G, Novak K, et al. European \u201cNAFLD Preparedness Index\u201d - Is Europe ready to meet the challenge of fatty liver disease? JHEP Rep. 2021;3(2):100234.","journal-title":"JHEP Rep."}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-022-02410-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-022-02410-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-022-02410-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,10]],"date-time":"2022-07-10T12:02:32Z","timestamp":1657454552000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-022-02410-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,10]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["2410"],"URL":"https:\/\/doi.org\/10.1186\/s12876-022-02410-x","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,10]]},"assertion":[{"value":"16 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was reviewed by the Western Institutional Review Board and was determined to qualify for exempt status due to the anonymous nature of the survey. All methods were carried out in accordance with relevant guidelines and regulations. The surveys were conducted in accordance with the principles and guidelines established by the Office for Human Research Protections, the Insights Association Code of Standards and Ethics, and the Declaration of Helsinki. Respondents reviewed information about the purpose and nature of the survey. Respondents selected a yes\/no option indicating informed consent to participate in the study prior to entering the screening portion of the survey. If they consented, they continued to the survey questions. Respondents could discontinue the survey at any time.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AA, TF, and JS are employees and shareholders of Novo Nordisk, Inc., which funded this research. DRC is employed by the Global Liver Institute, which has received grants and sponsorships from several companies in the NASH therapeutic space (990 publicly available). KN has no relevant financial conflicts of interest. MR has received consulting fees from 89Bio, Alnylam, Amgen, AMRA, BMS, Boehringer Ingelheim, Centara, Coherus, Cymabay, Fractyl, Galecto, Gelesis, Genfit, Gilead, Lipocine, Madrigal, Metacrine, Novartis, Novo Nordisk, Pfizer, Rivus, Sagimet, Siemens, Terns, Thetis, and Viking. MR has served on advisory committees for Enanta, Intercept, and NGM Bio.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"335"}}