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 24 May 2018

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News

The natural history of nonalcoholic fatty liver disease

Physicians, in the September issue of the American Journal of Gastroenterology, find that NASH has a variable histological course.

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In this study, physicians from Texas, USA, sought to define nonalcoholic steatohepatitis (NASH) histopathological change over time and correlate changes with the clinical characteristics.

The team identified patients with nonalcoholic fatty liver from a histopathology database, from 1985 to 2001.

In addition, they identified patients in clinic who had biopsy-confirmed NASH for more than 1 year. All the patients were evaluated and clinical data was obtained.

Any patients who qualified for NASH therapeutic trials underwent liver biopsy pretreatment.

Only 1 pathologist read the slides using a NASH grading and staging system.

32% of patients had increases in fibrosis score.
American Journal of Gastroenterology

The physicians found that 22 patients had repeat biopsies a mean of 5.7 years after the first biopsy. Of these, 9 were women, 9 had diabetes, 11 hypertension, and 14 hyperlipidemia.

The patients' mean body mass index was 33.8 kg/m2. They had a mean age of 50.6 years.

The team determined that 45% had fibrosis stage 1 or 2, and 9% had bridging fibrosis or cirrhosis (stage 3 or 4) on first biopsy.

They also found that 32% of patients had increases in fibrosis score, however, 18% had decreases in fibrosis score.

During the course of the study, the team found that the percentage of patients with stage 3 or 4 increased from 9% to 18%.

The team found that in 2 of the patients the disease progressed rapidly.

However, they determined that only serum AST at last biopsy correlated with histological change. This was higher in those whose disease had progressed.

Dr Stephen Harrison's team concluded, "NASH has a variable histological course".

"However, one third of patients have fibrosis progression, and one third of these have rapid progression to advanced fibrosis".

"Histological progression correlated with higher serum AST but no other clinical factors".

"Steatosis alone may progress to NASH with fibrosis".

Am J Gastroenterol 2003; 98(9): 2042-7
19 September 2003

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