Non-alcoholic Steatohepatitis

What is Nonalcoholic Steatohepatitis?

Nonalcoholic steatohepatitis (NASH) is a condition where there is fat accumulation and inflammation in the liver. NASH occurs in people who do not drink alcohol. The exact cause of NASH is unknown.

However, it is seen with increased frequency in people with certain medical conditions such as diabetes mellitus, obesity and high cholesterol and triglycerides.

NASH is typically a chronic condition (i.e. it persists for many years). Most people with this condition will not develop serious liver problems. On the other hand, in others the condition can lead to progressive scarring and cirrhosis. Unfortunately, it is difficult to predict the natural course of NASH in individual patients.

An illustration of a normal liver and fatty liver

An illustration of a healthy liver and fatty liver

What are the symptoms?

Most people with NASH have no symptoms. The condition is usually picked up during routine health screening when the liver function tests are abnormal.

Who are at risk for NASH?

Those who are overweight (BMI exceeds 23 for Asians and 25 for Caucasians). Those with diabetes mellitus, gout, hypertension and hyperlipidemia are at risk of developing NASH

How do you diagnose NASH?

Liver function tests usually show an elevated ALT or AST. Fatty infiltration of the liver is also seen on ultrasound of the abdomen. It is important to exclude viral hepatitis B and C as well as for other metabolic and autoimmune causes of liver disease through blood tests. Specific blood testes are currently available to evaluate the degree of fat accumulation in the liver, inflammation of the liver and liver fibrosis.

The gold standard test for the diagnosis of NASH is a liver biopsy. The biopsy will also help to determine the stage of the disease such as whether cirrhosis is present.

What is the treatment of NASH?

At this time, there are no treatments that cure NASH. The main goal of treatment is to control the conditions that are associated with NASH, such as obesity and hyperlipidemia. Several experimental treatments are being studied, but none can be routinely recommended.

Lifestyle measures such as weight reduction are the main stay of treatment but should be done gradually since, since rapid weight loss has been associated with worsening of liver disease

Picture of Steatosis, Activity and Fibrosis chart
Picture of a fatty liver under the microscope

An illustration of a healthy liver and fatty liver

What is the prognosis for patients with NASH?

The typical course of NASH is still being studied. About a third may progress to fibrosis and about 20% will develop cirrhosis over a period of 9 years

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