Nonalcoholic fatty liver disease (
NAFLD) has become a serious public health issue not only in Western countries but also in Japan. Within the wide spectrum of
NAFLD,
nonalcoholic steatohepatitis (NASH) is a progressive form of disease that often develops into
liver cirrhosis and increases the risk of
hepatocellular carcinoma (HCC). While a definite diagnosis of NASH requires liver biopsy to confirm the presence of hepatocyte ballooning, hepatic
fibrosis is the most important prognostic factor in
NAFLD. With so many
NAFLD patients, it is essential to have an effective screening method for
NAFLD with hepatic
fibrosis. As HCC with non-viral
liver disease has increased markedly in Japan, effective screening and surveillance of HCC are also urgently needed. The most common death etiology in
NAFLD patients is
cardiovascular disease (CVD) event. Gastroenterologists must, therefore, pay close attention to CVD when examining
NAFLD patients. In the updated guidelines, we propose screening and follow-up methods for hepatic
fibrosis, HCC, and CVD in
NAFLD patients. Several drug trials are ongoing for
NAFLD/NASH
therapy, however, there is currently no specific
drug therapy for
NAFLD/NASH. In addition to
vitamin E and
thiazolidinedione derivatives, recent trials have focused on
sodium glucose co-transporter 2 (
SGLT2) inhibitors and
glucagon-like peptide-1 (GLP-1) analogues, and effective
therapies are expected to be developed. These practical guidelines for
NAFLD/NASH were established by the Japanese Society of Gastroenterology in conjunction with the Japan Society of Hepatology. Clinical evidence reported internationally between 1983 and October 2018 was collected, and each clinical and background question was evaluated using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. This English summary provides the core essentials of these clinical practice guidelines, which include the definition and concept, screening systems for hepatic
fibrosis, HCC and CVD, and current
therapies for
NAFLD/NASH in Japan.