[Treatments of non-alcoholic steatohepatitis]

Non-alcoholic fatty liver diseases are highly prevalent in Western countries and associated with insulin resitance and metabolic syndrome. Non-alcoholic steatohepatitis (NASH) is characterized by lobular inflammation and hepatocellular ballooning, and may be associated with liver fibrosis leading to cirrhosis and its complications as hepatocarcinoma. The presence of obesity, type 2 diabetes mellitus or increased liver enzymes in patients with metabolic syndrome should prompt non-invasive screening (liver ultrasound, serum markers and/or transient elastography) to predict steatosis, NASH and fibrosis. Structured programmes aimed at lifestyle changes towards healthy diet and habitual physical activity are essential in patients with NASH. Currently, no drug is recognized definitively as efficient therapy in NASH and can be firmly recommended. Several emerging therapies targeting metabolic pathways, inflammation, fibrosis and apoptosis are evaluating in clinical phase II and III studies.