Categories: Hepatology

Non Alcoholic Steatohepatitis

What is this fatty liver? How fast can it progress? How did I get this? Can I have liver failure due to fatty liver? Can fatty liver lead to liver cirrhosis and liver cancer? These are few common apprehensions that pop up when people come to meet liver specialists or gastro doctors with a scan report that reads – Ultrasonographic features are suggestive of Fatty Liver. Through this article would like to address some of these.

What is a fatty liver, NAFLD and above all NASH?

Fatty liver is the accumulation of fat in the liver which can be caused by excessive alcohol intake, certain medications and virus infections (like Hepatitis C). And Non-alcoholic fatty liver disease (NAFLD) is xx, xx,

NAFLD affects 20-25% of the global population and is on course to become the most common cause of liver disease surpassing alcoholic liver disease. NAFLD can manifest in two ways – Non-alcoholic fatty liver where the liver has excessive fat but is not inflamed and Non-alcoholic steatohepatitis (NASH) in which the liver not only has excessive fat but is inflamed as well. The condition of NASH is the one that needs more attention.

People who drink too much alcohol can get a condition similar to NASH. But NASH is not related to drinking alcohol. NAFLD is more of a new world disease and is attributed to consuming excessive refined sugars and having a sedentary lifestyle. While the exact cause for NASH is still an enigma, what we know is that NASH is more common in people who are overweight, have diabetes, high cholesterol and take certain medicines causing fat accumulation in the liver.

All you need to know about NASH

NASH or fatty liver for that matter is a salient disease that is often diagnosed on abnormal routine labs or imaging. At most, people with NASH can have vague upper abdominal discomfort. People with advanced disease stage can present with jaundice, water accumulation in the abdomen and swelling of their feet.

The initial abnormal blood work needs to be followed up with more blood tests – mostly to rule out other causes of liver disease and imaging to arrive at the diagnosis. A liver biopsy where a small sample is taken from the liver to test under a microscope is the gold standard method to diagnose NASH. Being an invasive test, liver biopsy is now mostly avoided with the availability of a Fibroscan machine. Fibroscan of the liver not only gives an idea about how stiff (fibrosis) the liver is but also estimates the quantity of fat in the liver.

NASH is a chronic, life-long condition and it is difficult to predict its progression in any particular individual. But the good news is that many people with NASH do not develop serious liver issues and may maintain stable liver functions in the long run. However, in some people, NASH gets worse with time. Older people with diabetes are at increased risk for developing advanced liver disease. Once the diagnosis of NAFLD/NASH is made with certainty, we need to be aware of the prevention of its further progression to subsequent stages of liver cirrhosis.

Treatment and care:

Treatment of NASH focuses on controlling some of the medical conditions associated with it (such as diabetes and obesity) and monitoring for progression. Various drugs are undergoing trials for the treatment of NASH. The only treatment that doctors presently can prescribe as treatment for NAFLD/NASH with certainty is to lose weight. Gradual weight loss of up to 5-10% of the bodyweight is found to improve liver function. Appropriate treatment of associated conditions like diabetes, abstinence of alcohol also plays a role in slowing the progression of the disease. People presenting with very advanced liver disease symptoms must be treated as per the clinical condition.

To conclude, we need to be aware of NAFLD/NASH as it arises due to excessive accumulation of fat in the liver and can lead to progressive liver disease in some. Consultation with medical specialists will help you to recognise if you are at risk of disease progression so that you can take appropriate action.

Dr. Ravi Kiran | Consultant – Liver Transplant & HPB Surgery | Mazumdar Shaw Medical Center, Bommasandra, Bangalore

Narayana Health

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