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October 24 – What is nonalcoholic steatohepatitis (nonalcoholic steatohepatitis, NASH)?
Nonalcoholic steatohepatitis – or NASH – is a liver disease characterized by processes of inflammation, scarring and tissue death. It is linked to metabolic dysfunctions and the excessive presence of fat in its cells, and not to the consumption of alcohol. In fact, the fat can accumulate in the internal organs: it is called visceral fat and is particularly dangerous for health. When triglycerides are present in more than 5% of the cells of the liver, it is called foie gras, called "foie gras". In a subgroup of people, this pathology evolves into non-alcoholic steatohepatitis, which involves a high risk of progression in major liver diseases: fibrosis, cirrhosis (irreversible condition that compromises liver function) and hepatic carcinoma.
In medicine, these diseases are often referred to as Anglo-Saxon acronyms: NAFLD (non-alcoholic fatty liver disease) is a generic term that includes non-alcoholic fatty liver disease (non-alcoholic fatty liver disease) and non-alcoholic steatohepatitis. Non-alcoholic steatohepatitis, NASH).
epidemiology
Non-alcoholic fatty liver disease affects at least 25% of Italians, that is to say that at least one in four Italians have fatty liver disease. This percentage increases with age and especially increases in overweight people and diabetics, reaching 50% (one in two) in obese people. Even people of normal weight can still be at risk. In this case, waist circumference is a more accurate indicator of visceral obesity than body mbad index. Given the growing percentage of obese people in Italy, including children, the prevalence of steatosis and non-alcoholic steatohepatitis also increases and, from the point of view of liver disease, will represent an emergency in the future . It is estimated that in 2030, about 30% of Italians will have a fatty liver. With regard to NASH, the prevalence is estimated at about 4.4% and is expected to exceed 6% by 2030. In fact, if we now control hepatitis caused by viral factors, it is also true that NASH related complications, such as hepatocarcinoma. In order to raise awareness of the risks of NASH, the first International NASH Day was created on June 12th.
The diagnosis
Today, the first goal is to identify the people most at risk for liver damage. The problem lies in the fact that it is completely asymptomatic, and the same goes for NASH and even for liver lesions, as long as the situation is not very compromised: there is therefore no sign that can serve alarm bell. To direct the doctor must therefore be lifestyles and the presence of diabetes and / or obesity. An initial examination is the ultrasound of the upper part of the abdomen. Another screening method is based on liver elastography (or fibroscan), which uses ultrasound to evaluate the elasticity of the tissue: a healthy liver is soft and elastic, while a patient is more rigid, harder, because more fibrous. There are also two non-invasive tests already validated and widely used (FIB-4 and NAFLD FIBROSIS SCORE): they are very simple to perform because they combine variables such as body mbad index and blood values. The result is a score (score) that allows to exclude, with good reliability, liver damage and identify those who should be referred to a liver specialist. A third test (Enhanced Liver Fibrosis, ELF) is being evaluated.
It must be said that currently, the gold standard for establishing the diagnosis of NASH and proceed to the staging of fibrosis is biopsy of the liver, a procedure that is obviously invasive, expensive and not without risk. However, new models are emerging which, based on the three non-invasive tests and using machine learning technologies, may soon replace it. At the 2018 International Liver Congress in Paris (annual meeting of the European Association for the EASL Liver Study), two studies were presented on the usefulness and reliability of these new screening methods. non invasive. A first study showed that it is possible to predict the risk of progression of the disease in patients with advanced fibrosis due to NASH, while the latter has shown that it is possible to predict which patients are most likely to experience spontaneous improvement in fibrosis.
Therapies
Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis can regress simply by changing lifestyle. For example, it has been observed that a slimming of at least 7% of body weight is sufficient to trigger the regression of steatohepatitis and to improve fibrosis. In addition, a loss of more than 10% resolved 90% of NASH cases. To date, it is the only "therapeutic strategy" available to avoid a liver transplant.
Ongoing studies on pharmacological therapies
With regard to pharmacological therapies, hundreds of studies are ongoing on the mechanisms of fat accumulation, insulin resistance, inflammation and fibrosis. At the 2018 International Liver Congress in Paris, Gilead presented data from a concept validation study of 70 patients with NASH and liver fibrosis (stage F2 or F3). The results show that the treatment regimens of the study led to a greater reduction in fat mbad in the liver and that improvements in liver biochemistry and / or markers of fibrosis were observed in both cases. combined arms. With respect to tolerability, the frequency of adverse events was similar between patients treated with a single drug and those treated with combination therapy and none stopped treatment prematurely.
Source: Gilead
October 24, 2018
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