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Review
. 2016 May;61(5):1387-97.
doi: 10.1007/s10620-016-4083-8. Epub 2016 Mar 4.

Medical and Surgical Treatment Options for Nonalcoholic Steatohepatitis

Kathleen E Corey  1   2 , Mary E Rinella  3   4
Affiliations
Review

Medical and Surgical Treatment Options for Nonalcoholic Steatohepatitis

Kathleen E Corey et al. Dig Dis Sci. 2016 May.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the USA with a growing prevalence worldwide. Nonalcoholic steatohepatitis (NASH), progressive form of NAFLD, can lead to the development of cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Treatment of NASH may decrease the risk of progressive disease. Treatment for NAFLD should center around weight loss and exercise. Pharmacotherapy with vitamin E and pioglitazone should be considered for those with NASH, especially those with fibrosis. Weight loss surgery is also an effective treatment for NASH in individuals with other indications for surgery. In this review, we will discuss the currently available therapies for NASH including lifestyle, pharmacologic, and surgical options.

Keywords: Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Pioglitazone; Vitamin E; Weight loss surgery.

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Figures

Figure 1
Figure 1. Algorithm for management based on histologically characterized NAFLD using available agents
Patients with isolated hepatic steatosis have a low risk of progression over time. Those with ‘borderline’ histology characterized by steatosis with inflammation but no cellular ballooning not meeting criteria for NASH, are less well understood and repeat biopsy 3-5 years later should be considered. Patients with NASH should be encouraged to adopt lifestyle change, however in addition may benefit from pharmacological therapy. Therapeutic options listed here only include those currently available. There are no FDA approved drugs specifically for NASH.
Figure 2
Figure 2
Potential Impacts of Roux-en-Y Gastric Bypass on Nonalcoholic Fatty Liver Disease.
See this image and copyright information in PMC

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