C0493 - Patterns of GI Specialty Referral for Primary Care Patients With Nonalcoholic Fatty Liver Disease

John Bobo, MD, Andrew D. Schreiner, MD
Medical University of South Carolina, Charleston, SC

Introduction: Early specialist intervention for patients with significant fibrosis from nonalcoholic fatty liver disease (NAFLD) is important in preventing related morbidity and mortality. For patients with evidence of hepatic steatosis, we aim to determine what proportion received gastroenterology (GI) referral, the reason for referral, and the severity of fibrosis between groups.

Methods: This retrospective study of electronic health record data from 2012-2018 included patients with (i) radiographic reports of liver steatosis (abdominal ultrasound, CT, or MRI) and (ii) no competing, non-NAFLD chronic liver disease diagnoses.
Referral to GI any time after imaging was the primary outcome. Chart review was conducted to determine if a patient was referred and the reason for the referral. Fibrosis-4 Index (FIB-4) scores were calculated and categorized by advanced fibrosis risk. Statistical analysis was performed with Student t-tests and Chi-square tests using SAS.

Results: The cohort included 652 patients with a mean age of 55 (SD ± 14) years. Of included patients, 64% were female and 36% identified as Black. One in four patients received a formal diagnosis of NAFLD. FIB-4 scores were high-risk for advanced fibrosis in 12% of patients, indeterminate-risk for 31% of patients, and low-risk for 57% of patients.





Overall, 46% of patients received a GI referral, with 32% of these referrals being for colonoscopy. A larger portion of referred patients (33%) received a diagnosis of NAFLD during the study period compared to those not referred (19%, p< 0.001). Of patients referred for non-colonoscopy reasons, only 15% of referral orders mentioned steatosis. When fatty liver disease was mentioned at referral, a larger proportion of patients received a formal NAFLD diagnosis compared to all other non-colonoscopy referrals (80% vs. 26%, p< 0.001). There was no difference in the proportion of high-risk FIB-4 scores between patients with and without a GI referral (p=0.95).

Discussion: Appropriate GI referral for NAFLD management remains a concern, even so NAFLD is predicted to be the leading indication for liver transplantation within the next 10 years. Our data suggests hepatic steatosis is infrequently recognized as a notable finding on abdominal imaging and did not prompt excessive GI referral. Use of FIB-4 scoring has been shown to reduce unnecessary referral and improve detection of advanced fibrosis, though FIB-4 scoring did not influence referral likelihood in this cohort.


Disclosures:


John Bobo, MD, Andrew D. Schreiner, MD. C0493 - Patterns of GI Specialty Referral for Primary Care Patients With Nonalcoholic Fatty Liver Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.