Erste Daten zur Versorgungssituation von Patienten mit nicht alkoholischer Fettlebererkrankung (NAFLD) in Deutschland – Eine Umfrage an universitären hepatologischen Zentren

Zusammenfassung

Einleitung: Die nicht alkoholische Fettlebererkrankung (non-alcoholic fatty liver disease, NAFLD) stellt heutzutage in der westlichen Welt die häufigste Ursache einer chronischen Lebererkrankung dar. In der europäischen und US-amerikanischen Bevölkerung liegt die Prävalenz bei bis zu 30 %. Unklar ist die Versorgungssituation deutscher Fettleberpatienten.

Methoden: An sämtliche universitären Leberzentren in Deutschland (n = 34) wurden Fragebögen (11 Fragen) zur Versorgungssituation der NAFLD-Patienten verschickt. Gefragt wurde u. a. nach dem Anteil von Fettleberpatienten in den Hochschulambulanzen, metabolischen Begleiterkrankungen und der Art der Zuweisung. Auch wurden die klinikinternen Standards erfasst. Hierbei wurden die Situationen von 2008 und 2013 miteinander verglichen.

Ergebnisse: Die Rücklaufquote betrug 65 % (n = 22). Es zeigte sich, dass der Anteil von Fettleberpatienten in den Leberambulanzen zwischen 2008 und 2013 gestiegen war, wobei der überwiegende Anteil von Patienten in den meisten Zentren von extern und nicht aus der eigenen Klinik überwiesen worden war. Nur wenige Patienten wurden einem Diabetologen oder Endokrinologen vorgestellt, andererseits wurden aber durch die meisten Leberambulanzen Stoffwechselstörungen abgeklärt. Nur gering ausgeprägt war die Zusammenarbeit zwischen den Leberambulanzen und anderen Fachdisziplinen, diese wurde nur als mittelmäßig bewertet, gemeinsame Besprechungen wurden nur selten abgehalten. Verlaufskontrollen der Patienten finden in allen Zentren regelmäßig statt, allerdings nach unterschiedlichen Kriterien. Ein einheitlicher Algorithmus zur Risikobeurteilung und invasiven Diagnostik existiert nicht.

Schlussfolgerung: Das Problembewusstsein um NAFLD-Patienten scheint in den letzten Jahren gestiegen zu sein. Dennoch ist die Betreuung dieser Patienten heterogen, einheitliche Standards existieren nicht. Eine gemeinsame Leitlinie ist daher dringend erforderlich.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) currently is one oft the most common reasons for chronic liver injury in the western world. In the European and American population the prevalence is up to 30 %. The medical supply of German patients with NAFLD is variable and has not been analyzed to date.

Methods: We sent questionnaires to all university liver centers in Germany (11 questions) concerning the medical supply of patients with NAFLD. Questions included the rate of patients with fatty liver disease in the outpatient clinics, metabolic comorbidities and the kind of assignment. Besides that, individual clinical standards were documented. We compared longitudinal changes between 2008 and 2013.

Results: The return rate of questionnaires was 65 % (n = 20). Analysis showed that the portion of NAFLD patients in the university outpatient clinics had increased between 2008 and 2013 with the predominant part of patients being assigned from external practitioners and not from internal departments of the hospital. Only few patients were assigned by diabetologists or endocrinologists, but on the other hand most liver outpatient clinics investigated their NAFLD patients for metabolic disorders. Cooperation between liver outpatient clinics and other medical services was moderate and was rated average, joint conferences were held rarely. Follow-up visits of patients with NAFLD take place regularly in all centers, however based on different criterions. A consistent algorithm concerning risk assessment and invasive workup does not exist.

Conclusion: The awareness concerning patients with NAFLD seems to have grown in recent years. Nevertheless, the medical supply of these patients is quite heterogenous and consistent standards do not exist. Therefore, a common guidline is urgently required.

Schlüsselwörter

Fettleber - NAFLD - Versorgungssituation - Deutschland

Key words

fatty liver - NAFLD - medical care situation - Germany

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