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Non-alcoholic steatohepatitis
As its name signifies, Non-alcoholic steatohepatitis (NASH) is fatty
inflammation of the liver when this is not due to excessive alcohol
use. It is a major cause of cryptogenic cirrhosis of the liver.
Synonyms are Nonalcoholic Fatty Liver Disease or NAFLD.
History
Although NASH was described in 1980 in a series of patients of the
Mayo Clinic, it has only recently become a major interest of
clinicians.
Causes
The main cause is insulin resistance, which explains co-occurrence of
NASH and syndrome X.
NASH can also be caused by the following medications:
- Amiodarone
- Antiviral drugs (nucleoside analogues)
- Aspirin / NSAIDS
- Corticosteroids
- Methotrexate
- Nifedipine
- Perhexiline maleate
- Tamoxifen
- Tetracycline
- Valproic acid
Signs and symptoms
Although most patients with NASH are asymptommatic, but others present
with fatigue and abdominal discomfort.
Sometimes dull right upper quadrant pain is felt, occasionally
radiating to the right shoulder. Mild icterus (jaundice) can sometimes
be noticed.
NASH is associated with metabolic syndrome X,
diabetes mellitus (type
II) and insulin resistance.
Laboratory, imaging and diagnosis
Disturbed liver enzymes are common. Other tests generally performed
are other blood tests (erythrocyte sedimentation rate, glucose,
albumin, renal function etc.) As the liver is important in
coagulation, some coagulation studies will generally be done.
To distinguish this disease from viral hepatitis, blood tests
(serology) are generally done (hepatitis A, B, C, EBV, CMV and herpes
viruses, as well as rubella) to ensure these are not playing a role.
TSH is warranted, as hypothyroidism is more prevalent in NASH
patients.
Liver ultrasound is often done to distinguish the disease from
gallstone problems (cholelithiasis).
Usually, a liver biopsy will have to be done to distinguish NASH from
other causes of hepatitis.
Treatment
Trials are presently being conducted to optimize treatment of NASH.
Generally, treatment of underlying diabetes mellitus will be
undertaken, including weight loss and insulin sensitizing drugs (metformin,
pioglitazone or rosiglitazone).
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