Improving nonalcoholic fatty liver disease management by general practitioners: A critical evaluation and impact of an educational training program

Background/Aims. The epidemic diffusion of nonalcoholic fatty liver disease (NAFLD) represents an emerging problem in family medicine. General Practitioners (GPs) should pay attention to patients with fatty liver, look at associated conditions, identify causal factors and patients at risk of evolution. This study aimed to assess GPs' knowledge and practice and a training project impact about NAFLD. Methods. 56 GPs filled a questionnaire before and after attending a tailored workshop on NAFLD, and performed a clinical survey in patients with persistent hypertransaminasemia including screening and liver biopsy when indicated. Four months after a training workshop, GPs were questioned again about their practice changes with NAFLD. Results. At baseline, less than 30% of GPs considered NAFLD as a cause of persistent hypertransaminasemia; over two-thirds thought that NAFLD had a prevalence of 5-10% in the general population; about 50% considered hypertransaminasemia as the main indication for liver biopsy in NAFLD; their main approach included a low lipid-content diet. Comparison of pre/post workshop questionnaires showed significant improvements, despite knowledge on diet composition and steatogenic drugs remained poor. Among screened patients with hypertransaminasemia, NAFLD had a prevalence of 36% and was associated with the metabolic syndrome in more than 50%. Liver biopsy was obtained in 8% of NAFLD. Chronic viral hepatitis was better diagnosed than NAFLD (biopsy performed in 86% of cases). The training workshop resulted in practice changes concerning screening of risk patients, search for NASH and managing NAFLD in chronic viral hepatitis. Conclusions. GPs' knowledge about NAFLD appears barely adequate, thus targeted training is essential to improve their knowledge and practice.