The term “non-alcoholic steatohepatitis” (NASH)

Is a liver disease which closely resembles alcoholic liver disease but occurs in individuals consuming little or no alcohol. As with alcoholic liver disease the initial step in the evolution of NASH is almost certainly the deposition of excess fat within the liver. In patients who develop NASH the fat is associated with inflammation and scarring, which in a few cases may ultimately progress to cirrhosis (irreversible, potentially fatal, liver damage).

By far the majority of patients will be asymptomatic and the diagnosis is usually made after the finding of abnormal liver blood tests performed during routine investigations. Around 50% of patients will have fatigue and some right upper abdominal pain on direct questioning. The only abnormality on examination (prior to the development of cirrhosis) will be an enlarged liver.

Until recently, conventional wisdom has considered NASH to be a relatively uncommon and benign condition restricted largely to middle-aged, obese, diabetic women. However it has recently been recognised that NASH may be one of the most common liver diseases in the developed world and occurs in some individuals who are neither obese nor diabetic. Like non insulin-dependent diabetes mellitus (NIDDM) and coronary heart disease, NASH may be considered a “disease of affluence” and as a result is almost certainly increasing in frequency.

Of great concern are reports that NASH may be a progressive condition accounting for many cases of cirrhosis, previously considered to be “cryptogenic” (no known cause).

Factors associated with a more aggressive disease course appear to be more severe obesity, older age (more than 45) and established diabetes.. No treatments have been established as yet however, there is some preliminary evidence that gradual weight loss and exercise may improve the liver blood test abnormalities and in diabetics NASH would be a further reason to optimise glucose control. NASH can occasionally be caused by therapeutic drugs and can also occur following surgery for obesity.

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!!!This site is for information only. Professional, medical or other advice should be obtained before acting on anything contained in this site as no responsibility can be accepted by the owner of this site as a result of action taken or not taken because of the contents.!!!

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