ABSTRACT
The prevalence of obesity and the metabolic syndrome (MS) is on the rise, and subsequently
the hepatic manifestation of MS, nonalcoholic fatty liver disease (NAFLD), has become
a common entity in clinical practice. Most patients with NAFLD face medical complications
related to their underlying MS in other organ systems; however, a small but significant
group of patients with the more aggressive form of fatty liver, nonalcoholic steatohepatitis
(NASH), are at risk of developing cirrhosis and hepatocellular carcinoma. As patients
are generally asymptomatic, often their disease goes unrecognized. This is particularly
true for NASH, where liver biopsy is currently required to make the diagnosis. Once
diagnosed, no one treatment has been shown to be universally efficacious and those
that are of benefit are not without side effects. Effective treatment regimens directed
at both decreasing insulin resistance as well as the processes leading to necroinflammation
and hepatic fibrosis have been investigated and include lifestyle modification, surgical
therapies, and pharmacotherapy. This review focuses on current and potential future
therapies for NASH.
KEYWORDS
Fatty liver - nonalcoholic steatohepatitis (NASH) - nonalcoholic fatty liver disease
(NAFLD) - metabolic syndrome - thiazolidinediones (TZDs)
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Stephen A HarrisonM.D.
Chief of Hepatology, Brooke Army Medical Center
3841 Roger Brooke Drive, Ft. Sam Houston, TX 78234
Email: Stephen.harrison@amedd.army.mil