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Review
. 2015 Sep;90(9):1233-46.
doi: 10.1016/j.mayocp.2015.06.013. Epub 2015 Jul 26.

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Erin K Spengler  1 , Rohit Loomba  2
Affiliations
Review

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Erin K Spengler et al. Mayo Clin Proc. 2015 Sep.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the primary cause of chronic liver disease in the United States, afflicting an estimated 80 to 100 million Americans. Nonalcoholic fatty liver disease is a spectrum of liver diseases composed of nonalcoholic fatty liver and nonalcoholic steatohepatitis (NASH). Although nonalcoholic fatty liver has a negligible risk of progression, patients with NASH often develop cirrhosis or hepatocellular carcinoma. Although liver biopsy is required to diagnose NASH, only patients with a high risk of NASH or advanced fibrosis require this evaluation. Despite the high prevalence of NAFLD, well-defined screening recommendations are currently lacking. In this review, suggestions for screening, diagnosis, and initial work-up of NAFLD are given on the basis of established guidelines and recent publications. Proposed drug treatments of NASH are also discussed, highlighting the study outcomes, as well as proposed uses and limitations of these drugs. The literature was searched in PubMed using search terms nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, with filters of "English language." A date range of January 1, 2000, to May 1, 2015, was used for the search. The bibliographies of key references were also searched manually, and seminal publications before the year 2000 were included.

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Figures

Figure 1
Figure 1. Histopathology of NAFLD
A. 40x H&E image of NAFL Note the severe fatty change, numerous glycogenated nuclei (arrow) and lack of inflammation or balloon degeneration. B. 60x H&E image of NASH In addition to significant steatosis, there is evidence of ballooned hepatocytes (long arrow) and mixed inflammation including neutrophils (short arrow). C. 40x Klatskin trichrome stain image of NASH On this Klatskin stain the sinusoidal fibrosis characteristic of NASH is evident (zone 3). H&E = hematoxylin and eosin; NAFL = nonalcoholic fatty liver; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis
Figure 1
Figure 1. Histopathology of NAFLD
A. 40x H&E image of NAFL Note the severe fatty change, numerous glycogenated nuclei (arrow) and lack of inflammation or balloon degeneration. B. 60x H&E image of NASH In addition to significant steatosis, there is evidence of ballooned hepatocytes (long arrow) and mixed inflammation including neutrophils (short arrow). C. 40x Klatskin trichrome stain image of NASH On this Klatskin stain the sinusoidal fibrosis characteristic of NASH is evident (zone 3). H&E = hematoxylin and eosin; NAFL = nonalcoholic fatty liver; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis
Figure 1
Figure 1. Histopathology of NAFLD
A. 40x H&E image of NAFL Note the severe fatty change, numerous glycogenated nuclei (arrow) and lack of inflammation or balloon degeneration. B. 60x H&E image of NASH In addition to significant steatosis, there is evidence of ballooned hepatocytes (long arrow) and mixed inflammation including neutrophils (short arrow). C. 40x Klatskin trichrome stain image of NASH On this Klatskin stain the sinusoidal fibrosis characteristic of NASH is evident (zone 3). H&E = hematoxylin and eosin; NAFL = nonalcoholic fatty liver; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis
Figure 2
Figure 2. Epidemiology of NAFLD
It is estimated that 3–12% of the US population is affected by NASH. Although NASH patients have a higher risk of progression, it should be noted that some patients may progress directly from NAFL to advanced fibrosis. , Approximately 2–3% of patients with NASH cirrhosis will develop HCC each year. Some NASH patients without cirrhosis may develop HCC, but the magnitude of risk is not clear., sHCC = hepatocellular carcinoma; NAFL = nonalcoholic fatty liver; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; US = United States
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Comment in

References

    1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–2023. - PubMed
    1. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10:686–690. - PubMed
    1. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–285. - PubMed
    1. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology. 2007;133:1814–1820. - PMC - PubMed
    1. Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–131. - PubMed

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