Nonalcoholic Steatohepatitis

Nonalcoholic steatohepatitis is abbreviated as NASH. It is probably quite an underrated inflammatory liver disease, which, however, can be an important cause of liver cirrhosis with all its complications.


Nonalcoholic steatohepatitis can be translated to “normal language” as an inflammation of the liver due to liver deposition of fats unrelated to alcoholism. The most probable cause is the widespread unhealthy lifestyle with improper diet and lack of exercise leading to high cholesterol, hypertension, obesity and other components of the metabolic syndrome. The people with this syndrome surely have an increased risk of developing NASH.


NASH is associated with fatty liver (liver steatosis), which is accompanied by chronic inflammation of the liver tissue. This is a non-infectious inflammation, which is probably caused by a reaction of the organism to the liver cell damage by excessive fat accumulation in the liver tissue. Most people with NASH are asymptomatic, but about 10-20% may suffer from various nonspecific digestive symptoms and some patients develop even the stage of liver cirrhosis with all its complications (see the related article).


It is not so easy to state the right diagnosis. The patient usually has elevated liver tests and we have successfully ruled out common causes of liver damage such as infectious hepatitis, alcoholism, drugs, etc. Abdominal ultrasound shows either “only” fatty liver or sometimes the signs of cirrhosis. It is necessary to obtain a sample of liver tissue for histological examination, which can show us some findings typical for the NASH. The sample is acquired by a liver biopsy.


Patients diagnosed with NASH should be regularly checked by a physician with monitoring of the liver tests and liver ultrasound. The crucial aspect of the therapy is patient's cooperation, healthy diet and weight reduction. It is especially important not to drink alcohol, which could further damage the liver and worsen the condition. Some hepatoprotective drugs may be administered, but their effect is disputable. Certain positive effects against NASH have been reported in substances used for therapy of type 2 diabetes such as metformin.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources