Nonalcoholic Steatohepatitis: A Review of the Literature and Updates in Management

Lakshmi Pasumarthy, MD, FACP; James Srour, MD

Disclosures

South Med J. 2010;103(6):547-550. 

In This Article

Abstract and Introduction

Abstract

Nonalcoholic steatohepatitis is a common cause of liver inflammation and is associated with obesity, insulin resistance, and hyperlipidemia. There are concerns that it may turn out to be the most common cause of liver failure as prevalence of obesity increases. It leads to increased morbidity and mortality. Other causes of liver inflammation, especially alcoholic liver disease, must be ruled out. The diagnosis is suggested by abnormalities in the blood work and metabolic panel in an obese patient. Despite advances made in our understanding regarding the pathogenesis and trials with multiple drugs targeting mechanisms in pathogenesis, there are no consistent guidelines regarding treatment. However, multiple sources advocate weight reduction, optimum blood glucose control, and elimination of medications that cause fatty infiltration. The purpose of our article is to detail advances made in identifying disease mechanisms and treatment modalities, including surgery to promote weight loss.

Introduction

Fatty infiltration of the liver was described a long time ago and was initially felt to be linked with alcohol-related liver damage. The term nonalcoholic steatohepatitis (NASH) was introduced by Ludwig in 1980 and recognized in the absence of alcohol intake.[1] In the 1990s the incidence of nonalcoholic fatty liver disease (NAFLD) began to increase, paralleling the increase in obesity rates, and it is now recognized widely. The entity includes NAFLD which presents with simple steatosis, NASH, and cirrhosis. It is the most common cause of chronic liver disease. The estimated prevalence of NAFLD and NASH is 20–30% and 3.5–5%, respectively.[2] There is a higher prevalence of NASH in Mexican-Americans compared with non-Hispanic whites, even after controlling for obesity and body fat distribution.[3] The importance of NASH becomes more apparent when reviewing available data, which shows that 10–15% of patients with histologically proven NASH progress to cirrhosis and its complications such as liver failure and hepatocellular carcinoma. Furthermore, patients with NASH have lower survival rates.[4] Unfortunately, even though the prevalence of NASH threatens to increase, there are no approved medications for its treatment. There are many medications being evaluated currently, many targeting different steps in the development of hepatic steatosis or its progression to steatohepatitis. The laboratory and histologic profile of NASH and alcoholic liver disease are very similar. Distinction should be made carefully, since the treatment and prognosis are quite different.

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