Current treatment of non-alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) comprises a wide spectrum of pathologies ranging from non-alcoholic fatty liver (NAFL), characterized by simple steatosis without inflammation, to non-alcoholic steatohepatitis (NASH), characterized by steatosis of the liver accompanied by inflammation and hepatocyte ballooning, which can lead to advanced fibrosis, cirrhosis and hepatocellular carcinoma. Apart from lifestyle modifications such as weight loss, a Mediterranean diet and physical activity, only a few NAFLD-specific pharmacological treatment options such as Vitamin E and Pioglitazone are considered by current international guidelines. However, recently randomized controlled trials with GLP-1 agonists, FXR and PPAR ligands as well as other agents have been published and may expand the therapeutic armamentarium for NAFLD in the near future. Finally, knowledge about treating complications of end-stage liver disease due to NASH becomes an increasingly important cornerstone in the treatment of the broad disease spectrum of NAFLD. In this review, we summarize currently available and future treatment options for patients with NAFLD that may help internal medicine specialists treat the complete clinical spectrum of this highly prevalent liver disease.

Keywords: cirrhosis; fibrosis; non-alcoholic fatty liver disease; non-alcoholic steatohepatitis.

Fig. 1

Histological features of patients with NAFLD/NASH. (a) Collagen staining with subtle bridging fibrosis—NASH CRN fibrosis score 3. (b) HE staining with classical histological landmarks of steatohepatitis: macrovesicular steatosis, lobular inflammation and hepatocyte ballooning. (c) HE staining with mild steatosis and sporadic hepatocyte ballooning. Histological slides by courtesy of Dr.med. Behrang Mozayani, FRCPath, Department of Pathology, Medical University of Vienna.

Fig. 2

Current treatment options for NAFLD.