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Non-alcoholic steatohepatitis.

K Das1, P Kar

  • 1Department of Medicine, Maulana Azad Medical College and Associated LN Hospital, New Delhi - 2.

The Journal of the Association of Physicians of India
|June 2, 2005
PubMed
Summary

Non-alcoholic steatohepatitis (NASH), a subset of fatty liver disease, affects 2-3% of the population. Key risk factors include obesity and diabetes, with diagnosis often requiring liver biopsy for accurate prognostication.

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of conditions, with non-alcoholic steatohepatitis (NASH) being a significant subtype.
  • NASH affects 2-3% of the general population and is associated with obesity, diabetes, hyperlipidemia, and female sex.
  • The pathogenesis of NASH is often explained by the 'two-hit' theory, involving hepatic steatosis followed by inflammatory injury, potentially mediated by reactive oxygen species from mitochondria.

Purpose of the Study:

  • To review the epidemiology, pathogenesis, diagnosis, histological features, prognosis, and current/emerging therapies for non-alcoholic steatohepatitis (NASH).
  • To highlight the role of insulin resistance syndrome as a consistent metabolic association with NASH.
  • To emphasize the diagnostic criteria, including histological findings and exclusion of alcohol use.

Main Methods:

  • Review of existing literature on non-alcoholic steatohepatitis (NASH).
  • Analysis of epidemiological data, risk factors, and pathogenic mechanisms.
  • Evaluation of diagnostic methods, histological hallmarks, and prognostic indicators.
  • Assessment of current and investigational therapeutic strategies.

Main Results:

  • NASH is characterized by macrovesicular fat deposition, lobular inflammation with neutrophils, and perivenular/peri-sinusoidal collagen deposition.
  • The disease is progressive in over 25% of patients, with spontaneous regression occurring in less than 17%.
  • Liver biopsy is crucial for definitive diagnosis and prognostication, differentiating NASH from other chronic liver diseases.

Conclusions:

  • Lifestyle modifications like weight reduction, diabetes control, and exercise are primary therapeutic approaches.
  • Ursodeoxycholic acid shows potential in managing NASH by stabilizing cell membranes and reducing transaminase levels.
  • While liver transplantation is an option, NASH recurrence in transplanted livers is common; numerous novel therapies are under development.

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