Nonalcoholic Steatohepatitis (NASH)
Nonalcoholic Steatohepatitis (NASH) is a condition characterized by inflammation and the accumulation of fat and fibrous tissue in the liver. Although similar findings can be seen in patients who abuse alcohol, NASH occurs occurs in people who do not drink. The exact cause of NASH is not known. however, it is seen with increased frequency in people with certain medical conditions such as diabetes mellitus, obesity and hyperlipidaemia.
NASH is typically a chronic condition (ie, it persists for may 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. Cirrhosis is the term used to describe a diseased liver that has been severely scarred. Unfortunately, it is difficult to predict the natural course of NASH in individual patients.
Symptoms:
Most people with NASH have no symptoms . Very rarely, NASH is diagnosed after patients consult their doctor because of fatigue, a general feeling of being unwell, and vague discomfort in their upper right abdomen, although the relationship of these symptoms to NASH is unclear.
Diagnosis:
NASH is most often discovered during routine laboratory testing. Additional tests help to confirm the presence of NASH and rule out other types of liver disease.
Physical examination:
A physical examination may reveal an enlarged liver, but it is usually normal.
Liver function tests:
Liver function tests determine blood levels of substances produced or metabolized by the liver. They can be helpful for diagnosing NASH.
Other blood tests:
Additional blood tests are useful for ruling out other causes of liver disease. These usually include tests for viral hepatitis, and may include specific tests for less common cause of liver disease depending upon the clinical setting.
Imaging tests:
Imaging test (such as ultrasound, computed tomography, or magnetic resonance imaging) may reveal fat accumulation in the liver. However, these scans often fail to detect accumulation of fibrous tissue or inflammation and cannot differentiate NASH from other causes of liver disease that can have similar appearance.
Liver biopsy:
Although other tests may suggest that a person has NASH, a liver biopsy is the only test that can definitely confirm or rule out the presence of NASH. During a liver biopsy, small samples of the liver tissue are collected and sent to the laboratory for microscopic examination and biochemical testing.
A liver biopsy is also helpful for determining the severity of NASH, and in some cases, it may also provide clues about the future course of the condition. Sometimes, doctors will recommend gradual weight loss and watchful waiting for 6 months to 1 year before proceeding with a liver biopsy; abnormal results on liver function tests may return to normal with weight loss in some people.
Treatment:
At this time, there are no treatment 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.
Weight reduction may be helpful but should be done gradually since rapid weight loss has been associated with worsening of liver disease.
Prognosis:
The typical course of NASH is still being studied. Very few factors have been useful in predicting the course of this condition, although specific features in the liver biopsy can be helpful. The good news is that in most people, NASH appears to be a stable medical condition. The results of one study showed that people with NASH live just as long as people without this condition. Furthermore, the results of liver function tests remain the same over time in most people with NASH.
On the other hand, NASH can progress in some people. Studies that tracked liver damage in people with NASH who underwent several liver biopsies over time showed that the liver damage improved in about 3 percent of people, remained stable in 54 percent of people, and worsened in 43 percent of people.
- Nonalcoholic Steatohepatitis (NASH)
