Non-alcoholic fatty liver disease (NAFLD) is an umbrella term, which encompasses simple steatosis and non-alcoholic steatohepatitis (NASH).
The entire spectrum of NAFLD has been associated with metabolic syndrome. NASH is associated with increased mortality compared with that of the general population. Many therapeutic options for NASH have been studied.
However, there is very little evidence supporting the efficacy of most regimens for the treatment of NASH.
Dr Younossi and colleagues from Virginia, USA provided a review focusing on the current therapeutic options available for patients with NASH as well as to briefly introduce possible future interventions.
|NASH associated with metabolic syndrome can progress advanced cirrhosis|
|Alimentary Pharmacology & Therapeutics|
A MEDLINE, Pubmed and Cochrane Review database search using a combination of keywords, which included non-alcoholic fatty liver disease, non-alcoholic hepatic steatosis, NAFLD, NASH, treatment, therapeutics, vitamin E, orlistat and bariatric surgery.
An overall summary of the articles was developed for each section of discussion in this review.
The team found that NASH associated with metabolic syndrome can progress advanced fibrosis and cirrhosis.
Weight loss and lifestyle modification have been shown to improve NASH. Other medications used for weight loss and metabolic syndrome have been evaluated, such as orlistat, metformin and thiazolidinediones.
Alternative regimens using ursodeoxycholic acid, statins and probiotics as well as bariatric surgery have been evaluated, but have not been recommended as first-line treatment for NASH.
The researchers observed that Vitamin E for NASH patients without diabetes seems to be promising.
The lack of effective treatment for NASH suggests the heterogeneity of patients presenting with the NASH phenotype.
The researchers found that the best treatment strategy for these patients may be to identify their pathogenic target and develop personalised treatment protocols.
Dr Younossi and team concludes, "Currently, there are few options available for the management of NASH."
"Future targeted treatment strategies based on the pathogenic pathways may be needed to develop effective treatment for patients with NASH."