Background: Weight loss was shown to be associated with improvements in liver enzymes and improvements of nonalcoholic fatty liver disease. Objective: The aim was to assess the outcome of liver enzymes after a low-calorie diet (LCD) as well as during a follow-up period and to identify predictors for potential changes in these liver enzymes. In men, a significant decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was observed immediately after the LCD, whereas, in women, these enzymes increased significantly, although mildly; however, this increase was transient. Therefore, many studies were conducted to examine the effect of weight loss on NAFLD and NASH. Improvements in liver enzymes during weight loss were shown by some ( 4 , 9 , 10 ) but not all ( 5 , 11 ) researchers to be positively correlated with improvements in the radiologic or histologic appearance of the liver. To the best of our knowledge, we are the first to address this question in a relatively large cohort of subjects with normal or near normal liver enzymes [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] at baseline. Follow-up data at 32 and 60 wk after the end of the LCD were available for 67 subjects (47 women and 20 men) and 68 subjects (48 women and 20 men), respectively. The proportion of patients with normal liver histology increased after surgery, and the proportion of patients with steatosis decreased. However, the proportion of patients with steatohepatitis increased after surgery (14% before and 26% after surgery; P < 0.05). Andersen et al ( 5 ) studied the effects of weight loss induced by a very-LCD in 41 morbidly obese subjects (35 women and 6 men). The researchers observed a significant increase in portal inflammation (6 patients with portal inflammation before weight loss and 14 patients after weight loss; P = 0.039). However, it is unlikely that this occurred in our subjects, because the observed elevation of hepatic enzymes was transient, and no increase in GGT and ALP was noted. Finally, it may seem surprising that we found no correlation between age and changes in liver enzymes during the LCD. Moreover, we found no study that specifically examined correlations between age and changes in liver enzymes during weight loss.
Most people with NAFLD do not develop serious liver problems. In some people, the build-up of fat in the liver can lead to serious liver disease. For most people, simple fatty liver does not cause any harm or problems to the liver. Most people with NAFLD have simple fatty liver. It is not clear why some people with simple fatty liver progress to the more severe forms of NAFLD, and most do not. (However, most of these people have 'simple fatty liver' and not the more serious types of NAFLD.) Also, as NAFLD is common, some people with NAFLD also have another liver disorder, and NAFLD can make the other liver disorder worse. What are the symptoms of non-alcoholic fatty liver disease? Most people with simple fatty liver or NASH have no symptoms. The scan can show an enlarged liver compatible with the diagnosis of NAFLD. What is the treatment for non-alcoholic fatty liver disease? So, if you have simple fatty liver or mild NASH, this may prevent or delay the progression of NAFLD. For most people with NAFLD, the condition does not progress beyond simple fatty liver or NASH. So, most people with NAFLD do not develop serious liver disease.
Reverse The Causes of Fatty Liver Today. Fatty Liver Causes. Most people with a fatty liver are overweight. Each of these conditions can be a cause of fatty liver or a result of the condition. It is also possible to cure a fatty liver without drugs, this guide explains the natural way to cure fatty liver . This clearly gives hope and shows the way to reverse the cause of fatty liver disease through diet rather than expensive medical treatments. Fatty liver causes and being overweight. The majority of people with non alcoholic fatty liver disease are overweight. There are more overweight and obese people in the US than any other country, and more overweight people in the UK than anywhere in Europe. For most, the fundemental causes of becoming overweight are down to:
The liver is the second largest organ in your body and is located under your rib cage on the right side. The liver performs many jobs in your body. The liver also removes harmful substances from your blood. Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. NAFLD affects up to 25% of people in the United States. NAFLD may cause the liver to swell (steatohepatitis). NAFLD is initially suspected if blood tests show high levels of liver enzymes. Often, an ultrasound is used to confirm the NAFLD diagnosis. See a doctor who specializes in the liver regularly.
Diseases That Cause Rapid Weight Loss. Diseases That Cause Rapid Weight Loss Photo Credit Jupiterimages/Photos.com/Getty Images. Weight loss is a symptom of many different diseases, and only a trained professional is able to evaluate the accompanying symptoms in order to diagnose the problem. Weight loss is usually associated with diseases that involve the stomach and the digestive system. The gastrointestinal tract becomes inflamed when an individual has contracted Crohn's Disease (also known as Ileitis and Enteritis). The National Digestive Diseases Information Clearinghouse (NDDIC) reports that the causes of Crohn's are unknown, although the disease is frequently shared by family members. Hookworm infects an estimated 1.3 billion people worldwide, according to the Centers for Disease Control. In addition to weight loss, other symptoms include abdominal pain and lack of energy due to the decline in iron caused by the parasite.
Nonalcoholic Fatty Liver Disease — Strategies for Prevention and Treatment of an Emerging Condition. Research has shown that the risk of NAFLD is directly associated with and proportional to the degree of obesity, particularly truncal obesity.1,4. Insulin may also play a role in fatty liver disease by inhibiting lipolysis of fat in body cells and blocking mitochondrial beta-oxidation in the liver, stimulating the synthesis of new fatty acids from glucose. There is considerable research to suggest that NAFLD is associated with diabetes and progressive liver fibrosis and that NASH is associated with obesity and type 2 diabetes.1,2. Many scientists believe that the first step in preventing and treating NAFLD is achieving and maintaining a healthy weight. However, rapid weight loss with or without surgery may lead to fatty liver since it spurs the liver to produce endogenous fatty acids to make up for the fat missing from the diet.3 This is a concern that merits further exploration within NAFLD research. Liver enzyme and liver function monitoring should be made standard procedures to ensure the safety of studying dietary modifications for NAFLD. The current body of research suggests that the best way to prevent and treat NAFLD is to combine a healthful diet with regular exercise to achieve a healthy weight. A German study that appeared in the September issue of Gut involved 50 patients diagnosed with NAFLD and 120 patients without NAFLD at risk for metabolic diseases. More research on the connections between oxygenation of the hepatic tissues and NAFLD, as well as on treating conditions that often occur along with fatty liver disease, would help individuals avoid NAFLD with early treatments.4. Some data show that Mexican Americans are more likely to have NAFLD and African Americans are less likely compared with non-Hispanic whites.3 Advances in nutrigenetics may provide windows into the insulin, glucose, fat, and hormonal interactions that may contribute to fatty liver disease. • Liver biopsy (This is performed if clinical circumstances are highly suggestive of NAFLD and if the cost and risks of the biopsy seem to be worth the information that could guide treatment decisions.) Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome.
Numerous conditions can increase risk of fatty liver disease. The buildup of fat in the liver can result in inflammation and scarring (fibrosis). Although rare, the scarring can also harden the liver and impair its ability to function properly - a condition known as cirrhosis. A number of diseases and conditions can increase the risk of fatty liver disease. Certain medications, such as corticosteroids, and exposure to some toxins and chemicals also may contribute to fatty liver disease. Although no specific treatment exists, weight loss can improve and possibly even reverse fatty liver disease to some degree. Shedding excess pounds through diet and exercise or with the help of weight-loss (bariatric) surgery can prevent additional liver damage when inflammation and scarring is already present. A recent study of adults with NAFLD suggests that vigorous physical activity may also help reduce damage from fatty liver disease. It's also important that people with fatty liver disease avoid excessive alcohol and unnecessary use of medications, which can put stress on the liver. For instance, acetaminophen - a pain reliever found in many prescription and nonprescription drugs - can cause liver damage if more than the recommended amount is taken.
Home » Liver Problems » The Liver and Weight Loss. The Liver and Weight Loss. The liver is the major fat burning organ in the body and regulates fat metabolism by a complicated set of biochemical pathways. The liver can also pump excessive fat out of the body through the bile into the small intestines. Thus the liver is a remarkable machine for keeping weight under control, being both a fat burning organ and a fat pumping organ. If the diet is low in fiber, some of the fats (especially cholesterol) and toxins that have been pumped by the liver into the gut through the bile will recirculate back to the liver. A high fiber diet will reduce the recirculation of fat and toxins from the gut back to the liver. If the liver does not regulate fat metabolism efficiently, weight gain tends to occur around the abdominal area and a protuberant abdomen (pot belly) will develop. It can be almost impossible to lose this abdominal fat until the liver function is improved. Once this is done the liver will start burning fat efficiently again and the weight comes off gradually and without too much effort from you. What is effective in the long term is to eat the correct foods and nutrients for the liver to improve its fat burning function. Many middle-aged people with excess fat in the abdominal area have a “fatty liver”. In this condition the liver has stopped burning fat and has turned into a fat storing organ. If you have a fatty liver it is vital to be patient, as it can take between 3 and 12 months, depending upon the amount of fat deposited in the liver, to remove the excess fat from the liver.
Weight-Loss Shortcut Can Cause or Worsen Liver Disease. Even though losing weight is the best way to reduce the risk of fatty liver disease, how you shed the pounds is crucial to your liver’s health. Of the array of physical ailments that can blossom from having a high percentage of body fat, fatty liver disease ranks among the more perilous. Weight loss is the most obvious route for preventing fatty liver disease and other health concerns that stem from being overweight. Ironically, many turn to weight loss solutions that can actually hurt them more than being overweight. The following statistics demonstrate why weight loss is such a predominant concern: · Although it is the best way to maintain a healthy weight, only 26 percent of U. Because everything that is ingested eventually has to be processed by the liver, the components of a diet pill increase the stress on an already burdened liver. Even if the weight loss supplement is not believed to be toxic, this added stress increases the likelihood that an ailing liver will worsen rather than improve. Thus, manufacturers don’t need to prove to the Food and Drug Administration that their products are safe and effective before they can be sold to consumers. Considered to be one of the better weight loss supplements available, Hydroxycut is a prime example of a diet pill that can do more harm than good. There may be great temptation to take a weight loss pill such as Hydroxycut for those already diagnosed with or at risk for fatty liver disease. However, such a shortcut can easily spell disaster for a person’s liver. Considering that one quarter of American adults already has fatty liver disease – and many of those are undiagnosed – weight loss supplements such as Hydroxycut present a real danger. The only healthful way to shed excessive body fat and lower your risk of fatty liver disease is through diet and exercise.
The Liver Filter. The liver is the cleanser and filter of the blood stream and is of vital importance. It is only the liver that can purify the blood stream and we only have one liver. In such a liver, the liver cells and the spaces in the liver are filled with fat so the liver becomes slightly enlarged and heavier. The healthy liver is much redder in colour and has a uniform texture. Thus we call the liver the filter and cleanser of the blood stream. The consequences of a fatty liver. The healthy liver regulates fat metabolism and is the major fat-burning organ in the body. It also helps the liver to regulate cholesterol levels and improves immunity. A fatty liver can affect liver function and is associated with diseases of the liver such as cirrhosis. By improving his liver function and stabilizing blood sugar he will have the energy to exercise.
Weight loss is the primary treatment for obese patients with nonalcoholic fatty liver disease. The prevalence of nonalcoholic fatty liver disease becomes greater with increasing body weight. Statins have not been shown to be harmful in patients with elevated transaminase levels associated with nonalcoholic fatty liver disease. The diagnosis of nonalcoholic fatty liver disease requires exclusion of alcoholic liver disease and viral hepatitis ( Figure 2 ). Algorithm for the diagnosis of nonalcoholic and alcoholic fatty liver diseases. 5 However, patients with nonalcoholic fatty liver disease may have normal transaminase levels. The role of liver biopsy in nonalcoholic fatty liver disease is controversial. Obese children with elevated transaminase levels and fatty liver. The treatment group had significant improvement in liver enzyme levels and steatosis. Medications for treating hyperlipidemia also have improved biochemical and histologic findings in patients with nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease and the epidemic of obesity. The utility of radiological imaging in nonalcoholic fatty liver disease.
Fatty Liver. Fatty liver is the accumulation of fat in liver cells. There are a number of different conditions, medications, and poisons that can cause a fatty liver. Most fatty liver patients tend to be middle-aged and over weight. Some causes of fatty liver are: Fatty liver most often causes no problems. There are no medical or surgical treatments for a fatty liver or NASH, but improving your diet and increasing your exercise may help prevent or reverse some of the damage. Fatty liver may cause no damage or it can lead to an inflammation of the liver. Over time the liver may become scarred and hardened. About 10-20% of Americans have fatty liver and a smaller 2-5% has NASH.
This is a problem of stuck and stagnant fat congesting your liver. If you are too inactive then your liver is confronted by a huge problem of what to do with all the excess fat and sugar. Friendly flora is important to help protect against the caustic effects of bile, and so are higher amounts of DHA 6 – a natural degreasing compound for your liver that lowers your triglycerides. Each one of these problems stresses out your liver and contributes to the accumulation of fat in your liver. The rest of this article is devoted to strategies that speed up the process of unclogging your liver and improving your metabolism. If you are engaging the weight loss process while employing them, then your liver is improving. While you need to engage and sustain the process of weight loss to solve fatty liver problems over time, various nutrients can play a supportive role either by helping the fat flow or by protecting your liver. This nutrient can help your liver dispose of cholesterol and fat into your digestive tract without making extra bile that burns the lining of your digestive tract. This program is not a long-term strategy, it is more of a corrective strategy that also helps unclog your liver and rebalance your leptin system. Your liver is the brain of your body and it must work right for your metabolic and fat burning ability to be normal and healthy. This can be done by increasing lipotropic nutrients and nutrients that protect your liver.
Liver Function and Weight Loss. But if your doctor informs you that your liver function is impaired due to complications of fatty liver disease, you may have a chance to reverse that condition if you lose some weight. Nonalcoholic fatty liver disease appears to be tied to other obesity-related conditions, such as diabetes, and likely shares a common cause, according to the Veterans Health Administration. Up to 20 percent of Americans may suffer from nonalcoholic fatty liver disease, the Veterans Health Administration reports. Left unchecked, the disease can progress to a more serious condition called nonalcoholic steatohepatitis and cause permanent liver damage or even liver failure. Since fatty liver disease appears to share a strong link with diabetes and obesity, the same metabolic factors causing those conditions may also cause fatty liver disease, according to the Veterans Health Administration. Therefore, losing weight may help reverse fatty liver disease, just as it can help reverse diabetes.
When the liver gets fatty. Fatty liver affects between 70% and 90% of people with those conditions, so as obesity and diabetes have become more common, so has fatty liver disease. Estimates vary quite a bit, but it seems that 5% to 10% of people with fatty liver disease go on to develop NASH. Cirrhosis is irreversible and can lead to total failure of the liver. And NASH seems to add to the risks that come with excess weight. The fatty liver: How it starts and what it can lead to. Weight loss can make the liver less fatty. Excessive alcohol also make the liver fatty. Most people with fatty liver disease don't have symptoms, and that's true even if it has developed into NASH. Currently, a liver biopsy is the only way to make a definitive diagnosis of fatty liver or NASH. There's some evidence that a fatty liver may add to the already high risk of heart disease among people who are obese or have diabetes.
Liver - fatty liver disease. Fatty liver disease is a build-up of fats in the liver that can damage the organ and lead to serious complications. Causes of fatty liver disease. Risk factors for fatty liver disease. The risk factors most commonly linked to fatty liver disease are: Metabolic syndrome and fatty liver disease. Symptoms of fatty liver disease. Diagnosis of fatty liver disease. What is the likely cause of my fatty liver? Prevention and reversal of fatty liver disease. In general, if you have fatty liver, and in particular if you have NASH, you should:
If you seem to have more than an inch to pinch on your waist no matter what you eat or whether you focus on intervals or weight training, the problem may not be your stomach but another organ. You probably don’t give much thought to your liver (except maybe when you contemplate that third vodka soda), but its health is key to your overall health and weight. Because of all of this activity, your liver may be in need of a little TLC. Added together, this can mean that no matter how much you restrict calories, weight loss is near impossible—unless you detox your liver. Once you have the results, you can make the following lifestyle changes to help remedy and even reverse the problem. Use medications only when necessary, as even taking a Tylenol can have severe consequences on the liver. Your liver has to work harder to filter all this gunk.
The dangers of rapid weight loss increase with the time spent on the diet. Is Rapid Weight Loss Ever a Good Idea? Rapid weight loss diets can have ill effects, but so does obesity . VLCDs safely produce a loss of 15% to 25% of body weight in 12 weeks. Weight returns when the diet is stopped and happens rapidly; some experts say its best to take a more sustainable approach to weight loss comparable to that of regular diets. Most people seeking rapid weight loss, though, usually do it on their own.
Non-alcoholic fatty liver disease (NAFLD) is one of the causes of fatty liver , occurring when fat is deposited ( steatosis ) in the liver due to causes other than excessive alcohol use .  Non-alcoholic steatohepatitis (NASH) is the most extreme form of NAFLD, and is regarded as a major cause of cirrhosis of the liver of unknown cause. Native American men have a high prevalence of non-alcoholic fatty liver disease.[ citation needed ] Two genetic mutations for this susceptibility have been identified, and these mutations provided clues to the mechanism of NASH and related diseases.[ citation needed ] Polymorphisms (genetic variations) in the single-nucleotide polymorphisms (SNPs) T 455 C and C 482 T in APOC 3 are associated with fatty liver disease, insulin resistance , and possibly hypertriglyceridemia . NASH is a progressive disease: over a 10-year period, up to 20% of patients with NASH will develop cirrhosis of the liver, and 10% will suffer death related to liver disease. Epidemiological data have suggested that coffee consumption may be associated with a decreased incidence of NAFLD and may reduce the risk of liver fibrosis in those who already have NAFLD/NASH. The percentage of people with non-alcoholic fatty liver disease ranges from 9 to 36.9% in different parts of the world.    Approximately 20% of the United States population have non-alcoholic fatty liver, and the number of people affected is increasing. The rates of non-alcoholic fatty liver disease is higher in Hispanics, which can be attributed to high rates of obesity and type 2 diabetes in Hispanic populations.  Fatty liver and NASH occur all ages, with the highest rates in the 40- to 49-year-old age group.  NAFLD has been associated with the metabolic syndrome, which is a cluster of risk factors that contribute to the development of cardiovascular disease and type 2 diabetes mellitus.   Early diagnosis of NAFLD in children may help prevent the development of liver disease during adulthood.
Fatty Liver. Fatty liver is common. What Are the Symptoms of Fatty Liver? What Are the Causes of Fatty Liver? The most common cause of fatty liver is alcoholism and heavy drinking. What Are the Types of Fatty Liver? Nonalcoholic Fatty Liver. Alcoholic Fatty Liver. Alcoholic fatty liver is the earliest stage of alcohol-related liver disease. Abstaining from alcohol will likely cause the fatty liver to subside. Protecting your liver is one of the best ways to prevent fatty liver. What Is the Long-Term Outlook for Fatty Liver?
Obesity: Body Fat, the Silent Killer (cont.) The normal amount of body fat (expressed as a percentage of body weight) is between 25-30% in women and 18-23% in men. Another easier way of defining obesity is by calculating the body mass index ( BMI ). All of the stages of Nonalcoholic fatty liver disease are now believed to be due to insulin resistance, a condition closely associated with obesity.
Cirrhosis is chronic scarring of the liver. Rapid weight loss can cause fatty liver, which may degenerate to fulmanent hepatic failure. Loss of appetite can cause unintentional weight loss. Chronic liver disease; C. Sometimes the manifestations of liver disease are not obvious. Decreased appetite, Fatigue and Weight loss (unintentional) Web MD Symptom Checker helps you find the most common medical conditions indicated by the symptoms. They’ve lost weight and overcame chronic conditions like diabetes, heart disease and much, much more! Weight loss, decreased appetite, liver disease. The medical term for a loss of appetite is anorexia. Decreased appetite, Fatigue, Nausea or vomiting and Weight loss (unintentional) Web MD Symptom Checker helps you find the most common medical conditions indicated by.
Fatty Liver and Weight Loss. Weight loss is a crucial part in fatty liver treatment. Why weight loss is important in Fatty Liver.
Treatment of rapid weight loss in a donor with hepatic steatosis in living donor liver transplantation: a case report. To reduce the risk of liver injury, steatosis of the donor liver in living donor liver transplantation (LDLT) was treated with restricted diet and exercise. Consequently, the initial 80% steatosis was reduced to 10% and was accompanied by 13% weight loss for 81 days. Therefore, energy metabolism and NEFA levels represent important biomarkers for short-term intensive treatment by restricted diet and exercise in donors with hepatic steatosis.
Numerous Conditions Can Increase Risk of Fatty Liver Disease. Nonalcoholic fatty liver disease (NAFLD) — a condition in which excess fat accumulates in the liver of people who drink little or no alcohol — has become one of the most common liver diseases in the U. The buildup of fat in the liver can result in inflammation and scarring (fibrosis). Although rare, the scarring can also harden the liver and impair its ability to function properly — a condition known as cirrhosis. A number of diseases and conditions can increase the risk of fatty liver disease. Certain medications, such as corticosteroids, and exposure to some toxins and chemicals also may contribute to fatty liver disease. Although no specific treatment exists, weight loss can improve and possibly even reverse fatty liver disease to some degree. Shedding excess pounds through diet and exercise or with the help of weight-loss (bariatric) surgery can prevent additional liver damage when inflammation and scarring is already present. A recent study of adults with NAFLD suggests that vigorous physical activity may also help reduce damage from fatty liver disease. It's also important that people with fatty liver disease avoid excessive alcohol and unnecessary use of medications, which can put stress on the liver. Finally, people who have diabetes, high blood cholesterol or medical problems that may be contributing to fatty liver disease should work with their doctor to keep these conditions well managed, which in turn will help manage NAFLD.
Fatty liver disease is the most common form of liver failure in cats. Presentation and Signs of Fatty Liver Disease in Cats. Cats with fatty liver disease are often not eating or are not eating nearly the amount that they were before. Causes of Fatty Liver Disease in Cats. Diagnosis of Fatty Liver Disease in Cats. Screening Bloodwork: If your veterinarian suspects fatty liver disease based on the history and physical exam, some screening bloodwork may be performed. During Fatty Liver Disease, the cat's liver is not functioning well, so these test results will be abnormal. Ultrasound: This specialized form of radiology, when performed on the abdomen of a cat with fatty liver disease, may reveal that the liver is generally enlarged. Treatment of Fatty Liver Disease in Cats. The treatment of fatty liver disease in cats is aimed at reversing the malnutrition caused by the increase of fat and the decrease of protein supplied to the liver. There are several medications that may be necessary for a cat with fatty liver disease. Vitamin B 12: This vitamin may need to be supplemented during the treatment of Fatty Liver Disease. Potassium: Cats with fatty liver disease may be deficient in potassium and may need supplementation. Home Care of Fatty Liver Disease in Cats. The prognosis for a cat with fatty liver disease is very good (around 90% recovery) when it is treated appropriately and aggressively.
What is Non-alcoholic fatty liver disease (NAFLD)? What causes fatty liver disease? The most common cause of fatty liver disease in Canada is obesity. Fatty liver disease is the most common cause of liver disease in children. Fatty liver disease affects almost 3% of children and 22 – 53% of obese children. What are the symptoms of fatty liver disease? The treatment of fatty liver disease is related to the cause. Epidemiology of non-alcoholic fatty liver disease. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. GI epidemiology: nonalcoholic fatty liver disease. Non-alcoholic fatty liver disease. Dietary factors in the pathogenesis and care of patients with fatty liver disease. The epidemiology, pathogenesis and histopathology of fatty liver disease. Treatment of non-alcoholic fatty liver disease.
Fatty Liver Disease (NAFLD) How do I know if I have fatty liver disease? Fatty liver disease does not cause symptoms. Obesity and fatty liver disease. Non-alcoholic fatty liver disease is strongly associated with obesity. How much weight do I have to lose so I can cure my fatty liver disease? Can fatty liver disease make it harder for me to lose weight? Fatty liver disease should not make it harder for you to lose weight.
A liver biopsy is needed to confirm a diagnosis of NASH, the more severe form of NAFLD. The goal is to manage your risk factors and any health conditions. Your provider will help you understand your condition and the healthy choices that can help you take care of your liver. Getting vaccinated for diseases such as hepatitis A and hepatitis B. Talk to your provider about all medicines you take, including herbs and supplements and over-the-counter medicines. Losing weight and managing diabetes can slow or sometimes reverse the deposit of fat in the liver. Many people with NAFLD have no health problems and do not go on to develop NASH. Fatty liver; Steatosis; Nonalcoholic steatohepatitis; NASH. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Sleisenger & Fordtran's Gastrointestinal and Liver Disease.