Nonalcoholic steatohepatitis

Abstract

Nonalcoholic steatohepatitis (NASH) is a condition characterized by hepatomegaly, elevated serum aminotransferase levels, and a histologic picture similar to alcoholic hepatitis in the absence of alcohol abuse. Most patients with NASH are obese women, and many have diabetes mellitus, hypercholesterolemia, or hypertriglyceridemia. NASH has also been associated with a number of metabolic conditions, surgical procedures, and drug treatments. Most patients are asymptomatic. The most common sign of NASH is hepatomegaly. Stigmata of chronic liver disease are rare. Laboratory abnormalities include a 2-4-fold elevation of serum aminotransferase levels; other liver function test results are usually normal. Histologically, there is moderate to severe macrovesicular steatosis and lobular hepatitis with necrosis or ballooning degeneration and/or fibrosis. The pathogenesis of NASH is poorly understood, but lipid peroxidation and oxidative stress are the leading culprits. The natural history of NASH is unknown, but NASH seems to be a stable disease in most patients. Treatment of NASH is unproven, but weight reduction is recommended in obese patients. Small pilot studies of several drugs have shown promise, but large randomized clinical trials are awaited. Orthotopic liver transplantation is the treatment of choice for end-stage liver disease secondary to NASH.

Genes for systemic vascular complications are differentially expressed in the livers of Type 2 diabetic patients

“…This was especially evident in three subsets of differentially expressed genes encoding (i) transcription factors, (ii) cytokines and growth factors, and (iii) proteins associated with apoptosis. Diabetes is known to cause histological changes in the liver including NASH [13], and the difference in expression levels between diabetic and non-diabetic livers could therefore be related to these histological changes.…”

“…Informed consent was obtained from the diabetic patients both for this study and for the histolological examination of liver diseases, including non-alcoholic steatohepatitis (NASH), which is often associated with diabetes [13]. Liver biopsy specimens were obtained from all diabetic patients, immediately frozen in liquid nitrogen and stored at −80°C until use.…”

Effects of oligofructose on glucose and lipid metabolism in patients with nonalcoholic steatohepatitis: results of a pilot study

“…In humans, nonalcoholic steatohepatitis (NASH) is an asymptomatic disease often discovered incidently through elevation of serum aminotransferases on routine laboratory studies, or hepatomegaly examination and/or on discovery of liver hyperechogenicity on ultrasound (Agrawal & Bonkovsky, 2002). NASH is particularly frequent in patients with obesity, diabetes or hyperlipidaemia (Reid, 2001;Chitturi et al, 2002;Yu & Keeffe, 2002). No effective medical or nutritional treatment (except food restriction) has been proposed for patients with NASH until now (Luyck et al, 2000).…”

A Genomic and Proteomic Study of the Spectrum of Nonalcoholic Fatty Liver Disease *

“…[1][2][3][4][5] NAFLD includes a spectrum of clinico-pathological syndromes associated with varying degrees of risk for progression to cirrhosis. 1,6,7 For example, nonalcoholic steatohepatitis (NASH) is considered potentially progressive, whereas patients with liver biopsies showing steatosis alone follow a more benign course with little or no progression.…”

“…[8][9][10] The current rise in the prevalence of NAFLD and NASH may be related to parallel increases in the prevalence of obesity and metabolic syndrome. 2,4,5 Both endogenous and exogenous factors may influence differential progression of these liver diseases. [11][12][13][14][15][16] For example, environmental factors contributing to oxidative stress may compound hepatic injury in some patients, whereas genetic factors may be more important in others.…”