Quand adresser le patient diabétique à un hépatologue ?

Nonalcoholic steatohepatitis (NASH) is a major cause of liver disease, affecting 15 to 30% of the adult population. The prevalence is increased in the target populations by risk factors and varied from 45 to 89% especially in diabetic patients with the metabolic syndrome, for whom the risk, including mortality related to this liver disease, is higher. Determining the optimal time to refer the obese and/or type 2 diabetic patient to a hepatologist is therefore a public health issue. This consists in identifying the patients most at risk of histologically unfavorable evolution, and addressing to the hepatologist only the high-risk patients on the basis of objective criteria. And then to implement a therapeutic strategy to improve the clinic and the biology of patients. The interventions recommended in lighting using a screening and monitoring algorithm, based on the evolution of non-invasive markers of steatosis and fibrosis, then if necessary to a hepatologist for more invasive measures, such as elastometry and/or liver biopsy. Other diagnostic approaches are also being evaluated to manage these widespread chronic liver diseases in patients with metabolic risk.