Nonalcoholic steatohepatitis (NASH) – current treatment recommendations and future developments

Abstract

Nonalcoholic fatty liver disease (NAFLD) includes nonalcoholic fatty liver (NAFL), nonalcoholic steato hepatitis (NASH) and NASH cirrhosis. NAFLD is the leading cause of liver diseases in the Western world (Central Europe, United States). The NAFLD incidence increases because of increasing type 2 diabetes and obesity. This article reviews the scientific findings of epidemiology, diagnostic, and therapeutic management of NAFLD. Lifestyle modifications (low-caloric Mediterranean diet and exercise training) to reduce weight are a major factor in the treatment of NAFLD.

Pharmacological therapies may be useful in patients with NASH and fibrosis as well as nonresponders to lifestyle modifications. Currently, however, no pharmacological substances are approved for the indication NASH.

Zusammenfassung

Die nichtalkoholische Fettlebererkrankung (NAFLD) umfasst die nichtalkoholische Fettleber (NAFL), die nichtalkoholische Steatohepatitis (NASH) und die NASH-Zirrhose. NAFLD ist die Hauptursache für Lebererkrankungen in der westlichen Welt (Mitteleuropa, USA). Die NAFLD-Inzidenz steigt aufgrund der Zunahme von Typ-2-Diabetes und Fettleibigkeit. Diese Übersicht fasst den aktuellen Wissensstand bezüglich Epidemiologie, Diagnose und klinischem Management von NAFLD sowie zukünftige Therapieansätze anhand aktueller Leitlinien und Studien zusammen. Life-Style-Modifikationen (kalorienarme mediterrane Diät und Ausdauertraining) zur Erzielung eines Gewichtsverlustes sind das Hauptziel im Rahmen aktueller therapeutischer Empfehlungen zu NAFLD. Eine pharmakologische Therapie könnte bei Patienten mit NASH und Fibrose sowie Non-Respondern der Life-Style-Modifikationen hilfreich sein. Aktuell sind allerdings noch keine pharmakologischen Substanzen für die Indikation NASH zugelassen.

Key words

non alcoholic fatty liver disease - steato hepatitis - liver fibrosis

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