Clinical indicators for progression of nonalcoholic steatohepatitis to cirrhosis

Abstract

Non-alcoholic fatty liver disease (NAFLD), is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation, known as nonalcoholic steatohepatitis. Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma (HCC). Fatty liver disease prevalence has increased at alarming rates alongside obesity, diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide. Given this rise in prevalence, it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis. Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease. This article discusses the utility of current non-invasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available. Additionally, we summarize available treatment options including targeted medical therapy through four different pathways, surgical or endoscopic intervention.

Keywords: Cirrhosis; Hepatitis; Hepatocellular carcinoma; Histopathology; Imaging; Liver function tests; Nonalcoholic fatty liver disease; Steatosis.

Figure 1

Histologic progression of nonalcoholic fatty liver disease from simple steatosis to cirrhosis.

Figure 2

The spectrum of nonalcoholic fatty liver disease. NAFL: Nonalcoholic fatty liver; NASH: Nonalcoholic steatohepatitis; HCC: Hepatocellular carcinoma.