Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery

Abstract

This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected children.

Figure 1. Prevalence Distribution of Histology among Children with NAFLD

The prevalence of NASH among children with NAFLD varies on the setting. The highest prevalence of NASH among children with NAFLD is seen in fatty liver clinics. In a population-based study, SCALE (Study of Child and Adolescent Liver Epidemiology), fewer children with NAFLD had NASH. A lower rate of NASH was also reported in the bariatric surgery series.

Figure 2

Mean age and BMI of children diagnosed with NAFLD at a liver clinic versus those undergoing bariatric surgery. Children with a clinical diagnosis of NAFLD tend to be younger and less obese than children undergoing bariatric surgery. NAFLD studies references ,,,,. Bariatric surgery studies references ,–.