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Even if the mass of patients to be treated is important, we must distinguish those suffering from NASH from those those who are actually diagnosed with the disease. Indeed NASH is not easily diagnosed at this time which could explain why such an epidemic has occurred without the red lights of public health flashing earlier.

Currently, the only way to reliably diagnose NASH in a patient is by histological analysis of a liver biopsy. A biopsy is not a benign act, it carries a risk and can be painful. Further more, it is not a large scale diagnostic tool but a surgical act prescribed (and accepted) only when many other clinical factors indicate a serious liver problem. 

However, these metabolic factors are not obvious even in advanced cases of the disease. This is another reason that lead to some NASH analysts, rightly in this case, to limit the market solely to these formally diagnosed patients.

Unfortunately, as we have seen, if we can only diagnose those patients with advanced NASH we will sooner or later be faced with a major unresolved public health problem.

How can the health agencies avoid this?

- Make a big effort to communicate information about NASH to general practitioners who may only have discovered the existence of this disease very recently and know little about it.

- Persuade laboratories massively conduct research into advanced, non-invasive diagnostic techniques.

- In the absence of a reliable diagnostic technique  , intermediate indicators non-discriminatory and fully authorize, on the basis of this suspicion correlated NASH, chronic preventive treatment with the best safety profile and proven in its action the evolution of the disease. This curative treatment being prescribed at lower doses and prevention on a large scale in the population at risk such as reaching a NAFLD. This is exactly what has been done for the prevention of cardiovascular disease with statins.

Many laboratories have understood this and worked for many years on a multi-criteria method of diagnosis based on a set of biomarkers correlated by a computerized scoring system or on diagnosis based on imagery.

You can find more detail on diagnosis methods in this chapter 

You also can read a very good article that explains the state of the art in NASH diagnosis 

and this one on the NASH treatment strategies

It is planned now that within a year or two some reliable diagnostic systems will be available.


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