Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2020; 26(25): 3528-3541
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3528
Management of nonalcoholic fatty liver disease in the Middle East
Faisal M Sanai, Faisal Abaalkhail, Fuad Hasan, Muhammad Hamed Farooqi, Nawal Al Nahdi, Zobair M Younossi
Faisal M Sanai, Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia
Faisal Abaalkhail, Department of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
Faisal Abaalkhail, Department of Liver Transplant, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
Fuad Hasan, Department of Internal Medicine, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait
Muhammad Hamed Farooqi, Dubai Diabetes Center, Dubai Health Authority, Dubai 00000, United Arab Emirates
Nawal Al Nahdi, Department of Gastroenterology and Hepatology, Dubai Health Authority, Rashid hospital, Dubai 00000, United Arab Emirates
Zobair M Younossi, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA 22042, United States
Author contributions: All authors equally contributed to this paper in terms of conception, literature review, drafting, critical revision, editing, and final approval for submission.
Conflict-of-interest statement: None of the authors received any fees for writing this manuscript. Medical writing assistance was funded by Gilead Sciences. No other conflict is declared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zobair M Younossi, FAASLD, AGAF, FACG, FACP, MD, Chairman, Professor, Department of Medicine, Inova Fairfax Medical Campus, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA 22042, United States. zobair.younossi@inova.org
Received: March 5, 2020
Peer-review started: March 5, 2020
First decision: April 8, 2020
Revised: May 15, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: July 7, 2020
Processing time: 124 Days and 9.3 Hours
Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) in the Middle East is increasing in parallel to an increase in the prevalence of associated risk factors such as obesity, metabolic syndrome, and type 2 diabetes mellitus. About 20% to 30% of the patients progress to develop nonalcoholic steatohepatitis (NASH), a histological subtype of NAFLD, with features of hepatocyte injury such as hepatocyte ballooning. NASH can progress to fibrosis, cirrhosis, and even hepatocellular carcinoma. NAFLD thus causes a substantial burden on healthcare systems and it is imperative that appropriate strategies are discussed at a regional level to facilitate effective management tailored to the needs of the region. To fulfil this unmet need, expert gastroenterologists, hepatologists, and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia, United Arab Emirates, and Kuwait, to discuss current local challenges in NAFLD screening and diagnosis, and the different available management options. The experts discussed the disease burden of NAFLD/NASH in the Middle East; screening, diagnosis, and referral patterns in NAFLD; and available treatment options for NAFLD and NASH. This paper summarizes the discussions and opinion of the expert panel on the management of NAFLD/NASH and also presents an extensive literature review on the topic.

Keywords: Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Middle East; Expert opinion

Core tip: With the rising prevalence of nonalcoholic fatty liver disease (NAFLD) in the Middle East, there is an unmet need of appropriate strategies to facilitate effective management at a regional level. Therefore, expert gastroenterologists, hepatologists, and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia, United Arab Emirates, and Kuwait. Current local challenges in NAFLD screening and diagnosis, and the different available management options were discussed. This paper summarizes the discussions of the expert panel on the management of NAFLD/nonalcoholic steatohepatitis and also presents an extensive literature review on the topic.