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Nonalcoholic steatohepatitis 

Nonalcoholic steatohepatitis

Chapter:
Nonalcoholic steatohepatitis
Author(s):

Stephen F. Stewart

and Chris P. Day

DOI:
10.1093/med/9780199204854.003.152202_update_001

Update:

Increased use of noninvasive staging tools in clinical practice PIVENS trial supporting vitamin E.

Updated on 28 Nov 2012. The previous version of this content can be found here.
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date: 30 March 2017

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder in the developed world, affecting 20 to 30% of Western adults. Nonalcoholic liver disease occurs with a range of severity from simple steatosis through nonalcoholic steatohepatitis (NASH) to fatty fibrosis—and, ultimately, cirrhosis. The condition is a manifestation of the metabolic syndrome, strongly associated with obesity, insulin resistance, and dyslipidaemia; dietary and genetic factors appear to determine susceptibility to the disease and its progression.

In most patients the condition is discovered incidentally when abnormal values of serum liver-related liver tests are reported.. The diagnosis is usually one of exclusion: liver biopsy is not usually required , but is needed disease staging in some individuals. Treatment is directed at components of the metabolic syndrome: diet and exercise have been shown to reduce steatosis; metformin and pioglitazone can have beneficial effects on steatosis, inflammation and fibrosis in patients with type 2 diabetes; pharmacological antiobesity agents and other treatments are under evaluation.

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