Transhepatic intrahepatic portosystemic shunt (TIPS) stent placement is a minimally invasive procedure that, given the risk associated with surgical decompression, is preferred for the management of portal decompression. Drs. Bhogal and Sanyal discuss the procedure.

: NAFLD is associated with an increased risk of cardiovascular disease (CVD) and is frequently associated with metabolic syndrome. This creates a pressing need for the diagnosis and management of the comorbidities of NAFLD, including CVD. Drs. Corey and Vuppalanci guide clinicians in the assessment and management of metabolic disease and CVD in patients with NAFLD.

In the context of limited data and controversial approaches to screening, management of pediatric NAFLD presents many challenges for healthcare providers. Dr. Molleston outlines the reviews the best available evidence, recommends management approaches, identifies limitations in the current evidence base, and highlights other important aspects in the care of children with chronic liver disease, such as immunization against hepatitis A and B and counseling to avoid potential hepatotoxins such as alcohol.

Liver biopsy is the gold standard to confirm NASH, a progressive form of NAFLD. Biomarkers and clinical prediction rules for refining the management paradigm of NAFLD are emerging. Drs. Noureddin and Loomba discuss the noninvasive biomarkers that may be useful and indications for performing liver biopsy in patients with NAFLD.

The treatment of NAFLD is a patient-centered process that requires a patient to accept responsibility for lifestyle modifications. Evidence is emerging that allows physicians to guide patients better with diet and exercise counseling. Drs. Paredes, Torres, and Harrison explain.

In this introduction to CLD’s special issue on NAFLD, Drs. Puri and Sanyal define nonalcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), addressing histology, risk factors, and work up..

Current guidelines do not recommend the use of hepatic pharmacological therapy in patients with steatosis alone. Instead, patients with NASH and significant liver disease (bridging fibrosis) are good candidates for therapy. Dr. Ratzui outlines the current guidelines, best available evidence, and potential pharmacologic management of the patient with NASH.

NASH-related cirrhosis is the third most common indication for transplantation in the current era and accounts for 10% to 13% of transplants performed. The need for liver transplantation in patients with NAFLD is growing. Dr. Watt explains the impact of disease recurrence on short- and medium-term survival and addresses management approaches necessary to improve long-term survival.

Drs. Xanthakos and Kohli discuss the challenges in managing the pediatric patient with NAFLD, a growing patient population in both developed and developing countries. NAFLD in youth is often clinically silent and is discovered only upon screening or the incidental testing of serum aminotransferase levels.

NASH-related cirrhosis is the third most common indication for transplantation in the current era and accounts for 10% to 13% of transplants performed. The need for liver transplantation in patients with NAFLD is growing. Dr. Watt explains the impact of disease recurrence on short- and medium-term survival and addresses management approaches necessary to improve long-term survival.