ABSTRACT
Nonalcoholic steatohepatitis (NASH) is an hepatic disorder with histologic features
of alcohol-induced liver disease that occurs in individuals who do not consume significant
alcohol. NASH is believed to be one of the most common explanations for abnormal liver
chemistries in American adults. Risk factors for NASH include obesity, type II diabetes,
hyperlipidemia, total parenteral nutrition, jejuno-ileal bypass surgery, and the use
of certain drugs. However, some patients with NASH have no identifiable risk factors
for the disease. Clinically, NASH is a diagnosis of exclusion that should be suspected
as a cause of chronic hepatitis in patients who deny significant alcohol consumption
and have negative serologic tests for congenital and other acquired causes of liver
disease. The identification of fatty liver on imaging studies supports the diagnosis
of NASH, which can be established definitively by liver biopsy. The latter also provides
useful prognostic information since most patients with simple steatosis follow an
indolent clinical course, whereas those with steatohepatitis, fibrosis, or cirrhosis
are more likely to develop clinically significant complications of liver disease.
Weight reduction and treatment of confounding medical conditions are the mainstays
of therapy for NASH. However, there is little evidence that any of the current treatments
prevent progression to more histologically advanced stages of NASH. Several experimental
therapies, including treatment with bile acids, antibiotics, nutritional supplements,
and antioxidants, have had anecdotal success in selected patients, but improved understanding
of the pathogenesis and natural history of NASH will be required to develop generally
effective therapy for the disorder.
KEY WORDS
fatty liver - alcohol-like hepatitis - steatonecrosis
