Nonalcoholic steatohepatitis (NASH) is a common and in most cases “silent” liver condition. It appears similar to alcoholic liver disease, only it happens to people who do not drink too much alcohol. A critical characteristic of NASH is a condition called fatty liver accompanied by swelling and scarring of the liver. Many people with NASH appear healthy and are unaware they have a liver illness. Yet NASH can become severe and result in cirrhosis, where the liver is irreversibly damaged became incapable of working properly.
NASH is one of the leading causes of cirrhosis in the US. One possible reason as to why it has become more prevalent is the growing number of Americans with weight problems. About 2 to 5 percent Americans have NASH while 10 to 20 percent more have fatty liver but without the inflammation or liver damage. Although a fatty liver is not normal, it presents little harm by itself. Blood tests and liver scans can identify nonalcoholic fatty liver disease or NAFLD. Unfortunately, there are no reliable tests or scans that can diagnose NASH at this time.
The only way to accurately separate NASH from fatty liver is through a biopsy in which a small piece of the liver is taken and then examined. NAFLD is detected if the liver tissue has fat but no inflammation or any damage to the organ is observed. However, if scar tissue is present in the liver, then this points to NASH.
Symptoms
Oftentimes, NASH does not show any signs in the early stages of the disease. Hence, the nickname “silent disease.” People with nonalcoholic steatohepatitis normally feel well in the beginning. Symptoms like physical exhaustion, losing weight, and weakness only start to show once the disorder has progressed or when cirrhosis develops. NASH can take many years or even decades to evolve. In that span of time, two possibilities can occur: (1) the progression can halt and reverse without treatment or (2) the disease can advance gradually and cause fibrosis. When fibrosis gets worst, this is when cirrhosis starts to develop.
Not all NASH patients develop cirrhosis but once the liver becomes scarred, only a handful of treatments can help slow down the progression. A person diagnosed with cirrhosis can experience liver failure, intestinal bleeding, fluid retention and muscle wasting.
Causes
The disease mostly strikes middle aged or overweight people. Some people diagnosed with NASH are diabetic while many experience increase in blood lipids, including cholesterol and triglycerides. However, not all overweight or diabetic patients have NASH. In the same way that not all patients with NASH are overweight, have diabetes and high blood cholesterol levels. As a matter of fact, NASH can develop in children as well and and with no obvious risk factors. These simply indicates that NASH is not merely an obesity issue that damages the liver.
Even though NASH is now more common, the main cause of the liver problem that leads to NASH remains unclear. Cytokines and deteriorating liver cells are two possible factors but a lot is still unknown.
Treatment
No specific treatment for nonalcoholic steatohepatitis presently exists. NASH patients often have other pre-existing health conditions like diabetes and high blood pressure. It is recommended that people with NASH lose excess weight, keep a healthy and nutritious diet, exercise, abstain from alcohol and do not take unnecessary medications. These basic suggestions will also address the other health problems, such as cardiovascular illness, diabetes, and high cholesterol level. Transplant procedures in NASH patients have increased over the years. Liver transplant is the only solution left once the liver starts to deteriorate and cirrhosis has advanced.
Experimental methods that are under evaluation for NASH patients include giving antioxidants like Vitamin E, betaine, and selenium. These antioxidants cut down the activity of oxidative stress that seems to multiply in the liver cells of people with NASH. Another experimental method used for treating NASH is giving patients, those with high and normal blood sugar levels, the latest antidiabetic drugs. Newer medications against diabetes render the body more vulnerable to insulin and consequently might help lower liver damage. Whether or not these drugs can really assist in treating nonalcoholic steatohepatitis is not yet proven. However, the findings of medical studies should become available in the coming years.
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