Non－alcoholic fatty liver disease (NAFLD) affects around 30% of the global adult population and is an important cause of cirrhosis and hepatocellular carcinoma. Compared with other chronic liver diseases, NAFLD is mostly seen by primary care physicians and non-hepatologists. Though the absolute number is huge, only a small fraction of patients will eventually develop liver-related complications. Therefore, it is important to use noninvasive tests wisely and develop a care model that involves not only hepatologists but also other colleagues seeing patients with NAFLD. With this background, the American Gastroenterological Association commissioned a multidisciplinary group to provide guidance on a clinical care pathway for identifying patients with advanced liver fibrosis due to NAFLD. The 4 key steps of this pathway include ① identifying patients at risk at primary care or non-hepatology settings, ② initial assessment with history taking and physical examination, ③ screening for advanced fibrosis using simple fibrosis score, and ④ specific fibrosis test such as vibration controlled transient elastography in patients with indeterminate fibrosis scores. This article discusses the rationale of the recommendations and highlights areas needing further data and refinement.
