Non-alcoholic steatohepatitis in 2018

Nicolas Lanthier Published in the journal : May 2018 Category : Congrès UCL de Médecine Générale

Summary :

Non-alcoholic fatty liver disease (NAFLD) refers to all liver disease severity stages, characterized by a build-up of hepatic fat. In most patients, it is associated with the presence of a metabolic syndrome. The prevalence of NAFLD is increasing, along with that of the inflammatory condition called non-alcoholic steatohepatitis (NASH), which is characterized not only by steatosis but also by lobular inflammation and hepatocyte injury. NASH is associated with an increased liver-related (for advanced fibrosis stages) and non-liver-related morbidity and mortality (mainly due to cardiovascular events). While NASH diagnosis relies on histology, both steatosis and fibrosis can be evaluated by non-invasive methods allowing adequate treatment and follow-up.

What is already known about the topic?

Fatty liver (steatosis) is a common condition (25% of the population on average).

Steatosis can lead to a more severe, inflammatory and potentially fibrotic liver disease called non-alcoholic steatohepatitis (NASH).

What does this article bring up for us?

Advanced stages of fibrosis account for the liver-related morbidity and mortality associated with NASH. However, even in case of steatotic disease without fibrosis, all-cause morbidity and mortality are increased, mainly due to cardiovascular events.

Fibrosis and cirrhosis, but not NASH, can be suspected based on non-invasive screening by blood sampling and elastometry. Fibroscan® enables a reliable and rapid measurement of both ultrasound wave attenuation (evaluating steatosis) and liver elasticity (correlated with fibrosis).

Weight loss is beneficial to liver disease. Large studies are currently evaluating drug treatments and their impact on cardiovascular complications and long-term mortality.

Key Words

Steatosis, steatohepatitis, metabolic syndrome, fibrosis, cirrhosis, elastography