Gastroenterology & Hepatology

April 2019 - Volume 15, Issue 4

Letter From the Editor: Nonalcoholic Fatty Liver Disease and Pregnancy

Gary R. Lichtenstein, MD, AGAF, FACP, FACG


How does nonalcoholic fatty liver disease (NAFLD) affect pregnancy and the outcomes of both mother and child? In this month’s issue of Gastroenterology & Hepatology, a feature article by Dr Melissa Hershman, Ms Rena Mei, and Dr Tatyana Kushner explores this question. As the authors note, NAFLD has become the most common liver disease in the Western world and has a prevalence of approximately 10% among women of childbearing age. In their article, the authors examine the association between NAFLD and gestational diabetes mellitus, the effects that maternal NAFLD has on pregnancy and on the child, and how breastfeeding affects the health of both the mother and the child. 

Our other feature article focuses on the use of advanced practice providers (APPs) in gastroenterology practices, which is becoming more common. Dr John I. Allen, Dr Leslie Aldrich, and Mr Marc Moote describe the differences between nurse practitioners and physician assistants (common types of APPs in gastroenterology practices), billing and reimbursement considerations with APPs, various care delivery models that can be used to incorporate these providers into gastroenterology practices, and expectations regarding productivity.

The relationship between statins and hepatocellular carcinoma (HCC) protection is examined in our bimonthly HCC in Focus column. Among other issues, Dr David E. Kaplan discusses relevant study data, why statins might offer HCC protection, whether this effect might be stronger in certain types of statins, the optimal dose and length of statin therapy, and possible adverse effects that may occur in patients taking statins.

Our Advances in IBD column examines the treatment of Crohn’s disease with vedolizumab. Dr Brian Bressler discusses the perception that vedolizumab is slow-acting in Crohn’s disease, which Crohn’s disease patients would benefit the most from this treatment option and which patients should avoid it, where the drug should be positioned in the Crohn’s disease armamentarium, and its safety profile compared to other drugs, along with related issues. 

Treating gallbladder disease with endoscopy is the focus of our Advances in Endoscopy column. Among other issues, Dr Shayan Irani discusses how to perform transpapillary and transmural drainage of the gallbladder, the factors that should be taken into account when choosing an intervention, the advantages and disadvantages of each intervention (including possible adverse events), and study data on outcomes. 

In our Advances in Hepatology column, Dr Beatrice L. Madrazo examines magnetic resonance imaging (MRI) with gadolinium-based contrast agents for diagnosing liver disease. Her discussion includes the advantages of MRI, how gadolinium works, safety concerns involving the use of MRI with gadolinium, the first reports of gadolinium depositions in patients, whether gadolinium should be avoided in any patients, and the use of ultrasound contrast agents. 

Finally, our Advances in GERD column highlights the use of simulators in training programs for upper gastrointestinal (GI) endoscopy. Along with related issues, Dr Karen L. Woods describes the evolution of training for upper GI endoscopy, the various simulator models that are currently available and how they were validated, the advantages and disadvantages of training with GI endoscopy simulators, and barriers to incorporating these tools in training programs.

May this issue provide you with helpful information that you can put to good use in your clinical practice.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc