Clinical Dilemmas in Non-AlcoholicFatty Liver Disease offers hepatologists practical, up-to-date and expert guidance on the most topical dilemmas, difficulties and areas of controversy/difficulty surrounding this ever-increasing area of liver disease they face in daily practice.

Roger Williams and Simon Taylor-Robinson, two of Europes leading hepatologists, have recruited leading figures from across the world to assist them, resulting in a truly international approach.  Each chapter covers a specific area of difficulty, containing clear learning points and providing evidence-based expert guidance on the latest hot topics in clinical management such as:

Is NAFLD different in absence of Metabolic Syndrome?Are the pros outweighed by the cons of obtaining a liver biopsy?Is progression to cirrhosis more likely in children with NAFLD?What are the dangers as well as the true benefits of bariatric surgery?How is it best to use antifibrotic agents in clinical practice?

Clinical Dilemmas in Non-AlcoholicFatty Liver Disease provides the answers to the questions and challenges that clinicians face every day in this area.  It is essential reading for hepatologists of all levels and researchers in hepatology, as well as all those involved in the care of patients with NAFLD, including gastroenterologists, pathologists and specialist hepatology nurses.

Professor Roger Williams CBE, runs the Institute of Hepatology at UCL, and is a twice former president of EASL. He has authored an incredible 2100 journal articles. Despite advancing years, he is still actively involved in clinical research -- 340 articles in the past ten years, and analysis by ISI shows him to be one of the most influential researchers in his field. The award of a CBE for services to medicine recognised his major contribution to the study of liver disorders over 25 years including leading the team who performed the first ever UK liver transplant. He also performed George Best's controversial liver transplant in 2002.Prof Williams has had many awards, medals, honorary fellowships, and in 2006 was included by HRH The Queen in a celebration at Buckingham Palace to honour those who continue to contribute to public service beyond the age of 65yrs. He was made a Fellow of King's College London in 1992 and an Honorary Fellowship from UCL was conferred on him in 2008, in recognition of his distinguished career and outstanding service to UCL.

Professor Simon Taylor-Robinson joined the Department of Medicine at Imperial College London in 1997, having previously been Senior Registrar in Gastroenterology and Hepatology at Hammersmith Hospital. He was awarded the Sir Francis Avery Jones Gold Medal by the British Society of Gastroenterology in 1999 and the Young Investigator Award of the Liver Section of the European Gastroenterology Association in 1997. He is currently Director of the Imperial Clinical Research Facility at St Mary's Hospital, London.

List of Contributors vii

Preface ix

Part I: Nature of the condition

1 Non-alcoholic fatty liver disease: Hype or harm? 3Stephen H. Caldwell and Curtis K. Argo

2 NAFLD: A worldwide problem 8Joanna K. Dowman Geoffrey C. Farrell and Philip Newsome

3 Is insulin resistance the principal cause of NAFLD? 15Ian F. Godsland Sanjeev Mehta Shareen Forbes Fabian Meienberg Michael Yee Simon D. TaylorRobinson and Desmond G. Johnston

4 Paediatric NAFLD: A distinct disease with the propensity for progressive fibrosis 29Emer Fitzpatrick and Anil Dhawan

5 Nonalcoholic fatty liver disease (NAFLD) as cause of cryptogenic cirrhosis 36Jay H. Lefkowitch

6 Is NAFLD different in absence of metabolic syndrome? 44Yusuf Yilmaz

7 Occurrence of noncirrhotic HCC in NAFLD 50Dawn M. Torres and Stephen A. Harrison

8 Fibrosis progression: Putative mechanisms and molecular pathways 61WingKin Syn and Anna Mae Diehl

9 When is it NAFLD and when is it ALD?: Can the histologic evaluation of a liver biopsy guide the clinical evaluation? 72Elizabeth M. Brunt and David E. Kleiner

10 Of men and microbes: Role of the intestinal microbiome in non-alcoholic fatty liver disease 82Muhammad Bilal Siddiqui Mohammed Shadab Siddiqui and Arun J. Sanyal

11 Can genetic influence in nonalcoholic fatty liver disease be ignored? 91YangLin Liu Christopher P. Day and Quentin M. Anstee

12 Is there a mechanistic link between hepatic steatosis and cardiac rather than liver events? 103Soo Lim

Part III: Diagnosis and Scoring

13 How to best diagnose NAFLD/NASH? 113Vlad Ratziu

14 The clinical utility of noninvasive blood tests and elastography 124Emmanuel A. Tsochatzis and Massimo Pinzani

15 Are the guidelinesAASLD IASL EASL and BSGof help in the management of patients with NAFLD? 131Cristina Margini and JeanFrançois Dufour

16 Imaging methods for screening of hepatic steatosis 138Hero K. Hussain

17 Are the advantages of obtaining a liver biopsy outweighed by the disadvantages? 152Jeremy F. L. Cobbold and Simon D. TaylorRobinson

18 Screening for NAFLD in highrisk populations 161Nader Lessan

Part IV: Value of treatment measures

19 Defining the role of metabolic physician 173Nicholas Finer

20 Should physicians be prescribing or patients selfmedicating with orlistat vitamin E vitamin D insulin sensitizers pentoxifylline or coffee? 182Haripriya Maddur and Brent A. NeuschwanderTetri

21 Effects of treatment of NAFLD on the metabolic syndrome 189Hannele YkiJärvinen

22 What are the dangers as well as the true benefits of bariatric surgery? 196Andrew Jenkinson

23 Liver transplantation: What can it offer? 203Roger Williams

Part V: What does the future hold?

24 Molecular antagonists leptin or other hormones in supplementing environmental factors? 211Jonathan M. Hazlehurst and Jeremy W. Tomlinson

25 What is the role of antifibrotic therapies in the current and future management of NAFLD? 218Natasha McDonald and Jonathan Fallowfield

26 Developmental programming of nonalcoholic fatty liver disease 226Jiawei Li Paul Cordero and Jude A. Oben

Index 232