Non-Alcoholic Steatohepatitis

Non-Alcoholic Steatohepatitis is a newly recognized condition which likely has been around for a long time. It is diagnosed and treated by the GI Division of Premier Medical Group. It means presence of fat in the liver, even in the absence of significant alcohol ingestion.

There are two types of fatty liver disease: non-alcoholic fatty liver disease, a benign version, and non-alcoholic steatohepatitis which can lead to chronic liver disease and cirrhosis. This is usually caused by obesity, genetic predisposition, and lipid disorders (high cholesterol, LDL, triglycerides, etc.).

Non-Alcoholic Steatohepatitis affects 2-5% of Americans. In the past 10 years, obesity has doubled in adults and tripled in children. Obesity leads to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH.

What causes non-alcoholic steatohepatitis?

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Most people with NASH are 40-50 years old, obese, have Type 2 diabetes, high cholesterol or metabolic syndrome. Research does not explain why some people who have a fatty build up in the liver get NASH while others do not. It’s possible that something in the environment triggers the inflammation, or that it runs in their families. Although NASH seems to appear in persons who are middle-aged and overweight, some people who have NASH are not obese, do not have diabetes, and have normal cholesterol levels. NASH can transpire without any seeming risk factor and can even occur in children. Several factors that may lead to liver injury are:

  • insulin resistance
  • release of toxic inflammatory proteins by fat cells (cytokines)
  • oxidative stress (deterioration of cells) inside liver cells

What are the symptoms of non-alcoholic steatohepatitis?

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Nonalcoholic fatty liver disease is usually a silent disease with few or no symptoms. If you do show symptoms, they may include:

Make an appointment with your doctor if you have persistent signs and symptoms. The progression of NASH can take years, even decades, and it can completely stop and even reverse itself. It can also become worse, causing scarring to appear and accumulate in the liver. When the scarring (or fibrosis) progresses, cirrhosis develops and the liver becomes seriously scarred, hardened, and unable to function normally. This does not mean that everyone with NASH gets cirrhosis, but once it does develop, it’s rare to stop the progression of the disease. Once cirrhosis is present, a person could experience fluid retention, bleeding from the intestines, muscle wasting, and liver failure. NASH ranks as one of the major causes of cirrhosis in America, behind hepatitis C and alcoholic liver disease.

How is non-alcoholic steatohepatitis diagnosed?

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As in any diagnosis, the first part is a complete medical history and physical exam. Your doctor may order an ultrasound or a CT scan. If he or she suspects NASH, a liver biopsy may be necessary. NASH is usually detected with the results of blood tests. If your doctor rules out all other reasons for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x-rays or imaging studies of the liver show fat, NASH is generally suspected. The only way to be certain of the diagnosis is to perform a liver biopsy. A biopsy will also show if there is scarring in the liver.

What are other types of nonalcoholic fatty liver disease?

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There are several forms of Nonalcoholic fatty liver disease:

Nonalcoholic fatty liver (NAFLD)

This condition is very common, and while it’s not normal for fat to build up in your liver, it’s not necessarily a health issue. Generally this does not cause complications.

Nonalcoholic steatohepatitis (NASH)

In some people with fatty liver, the fat causes inflammation in the liver. This inflammation can cause complications and weaken the liver’s ability to function.

Nonalcoholic fatty liver disease-associated cirrhosis

Inflammation in the liver leads to scarring of the liver tissue. In some cases, the scarring can become so severe that the liver no longer functions adequately (liver failure).

How is non-alcoholic steatohepatitis treated?

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Currently there is no real treatment for NASH. You can manage the damage to your liver by limiting your risks by:

  • Reducing your total cholesterol level
  • Maintaining a healthy weight
  • Controlling diabetes
  • Reducing or stopping alcohol intake
  • Exercising regularly
  • Reviewing your medications with your doctor, as some may be harmful to your liver