# Perspectives of Indian Gastroenterologists and Hepatologists on Nonalcoholic Fatty Liver Disease Diagnosis and Management: Insights From the Nationwide Web-Based Cross-Sectional DRIVE Survey

## TL;DR

A nationwide survey in India reveals how gastroenterologists and hepatologists diagnose and manage nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, highlighting challenges like limited awareness and treatment options.

## Contribution

The study provides real-world insights into diagnostic and management practices for NAFLD/NASH among Indian physicians, revealing gaps and heterogeneity in approaches.

## Key findings

- Transient elastography is the most preferred diagnostic tool for NAFLD/NASH among Indian physicians.
- Pharmacotherapy with antioxidant vitamins and saroglitazar is commonly used, but limited treatment options remain a major barrier.
- Lack of patient awareness and effective therapies are identified as key challenges in managing NAFLD/NASH in India.

## Abstract

Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), represent an increasing clinical and public health burden in India. Despite their high prevalence, there are limited data on their diagnostic and management approaches among Indian health care providers. Real-world evidence on how Indian gastroenterologists and hepatologists diagnose and manage these conditions remains limited.

This study aimed to understand the current disease perspectives, diagnostic modalities, and management practices for NAFLD and NASH among Indian hepatologists and gastroenterologists.

A nationwide, web-based cross-sectional survey was conducted online between May 2023 and July 2023 among practicing gastroenterologists and hepatologists from health care setups, clinics, and hospitals located across India. The structured, self-administered questionnaire included 34 items covering 3 domains: disease perspectives (n=16), diagnostic modalities (n=4), and management strategies (n=14). Descriptive statistics were used to summarize responses as counts and percentages.

A total of 609 physicians completed the online survey (gastroenterologists: n=556, 91.3%; hepatologists: n=53, 8.7%). For 336 (55.2%) physicians, NAFLD accounted for 25% to 50% of the patients consulted per month, and 220 (36.1%) physicians reported that 10% to 20% of patients with NAFLD had NASH. Obesity (n=583, 95.7%) and diabetes (n=579, 95.1%) were cited as leading risk factors for NAFLD. Transient elastography was the diagnostic tool preferred by 558 (91.6%) physicians, followed by NAFLD fibrosis score (n=378, 62.1%) and Fibrosis-4 score (n=356, 58.5%); only 154 (25.3%) physicians used liver biopsy. For treatment, 414 (68%) physicians managed patients using pharmacotherapy and dietary and lifestyle modifications, while 195 (32%) relied on lifestyle modification alone. Antioxidant vitamins (n=543, 89.2%) and saroglitazar (n=522, 85.7%) were the most frequently prescribed therapies. The main barriers to optimal NASH management reported were lack of patient awareness (n=466, 76.5%) and limited availability of effective pharmacological options (n=303, 49.8%).

This large, nationwide survey highlights that NAFLD and NASH constitute a major part of gastroenterology and hepatology practice in India. Although transient elastography and pharmacological agents such as saroglitazar and vitamin E are widely used, considerable heterogeneity exists in diagnostic and management approaches. The lack of patient awareness and effective treatment options remain the major hurdles in managing NAFLD and NASH. These findings underscore the need for the wider implementation of existing India-specific consensus recommendations, continued physician education, and future research focusing on tailored interventions in the management of NAFLD and NASH for the Indian population.