Liver Inflammation and Scarring: Signs, Causes, Remedies, and Prognosis
Steatohepatitis, an advanced stage of fatty liver disease, can lead to serious complications if left untreated. This condition, which primarily affects the liver, can progress to cirrhosis, end-stage liver disease, and even hepatocellular carcinoma (HCC). Both alcoholic steatohepatitis (ASH) and nonalcoholic steatohepatitis (NASH) share these key long-term complications, and they also increase the risks for liver-related mortality. In severe cases, liver transplantation may be required.
Alcoholic Steatohepatitis (ASH)
ASH, caused by excessive alcohol consumption, requires abstinence from alcohol as a critical step to prevent disease progression and improve liver outcomes. Nutritional support and management of alcohol use disorder (AUD) with behavioral therapy and pharmacologic treatments are essential. Post-liver transplantation, monitoring for relapse is important, using biochemical markers and validated questionnaires like the AUDIT-C. Liver transplantation is considered for end-stage disease, but careful assessment of relapse risk and management of AUD is necessary.
Nonalcoholic Steatohepatitis (NASH)
NASH, associated with conditions such as diabetes, requires lifestyle modifications, including weight loss of 7-10% body weight through diet and exercise, to improve histology and reduce fibrosis progression. Control of associated metabolic risk factors such as hyperlipidemia (with statins), hypertension, and diabetes is key. Avoidance of alcohol is also recommended as it can accelerate fibrosis progression in NASH. Emerging pharmacologic treatments such as resmetirom (a thyroid hormone receptor beta agonist) are under investigation and sometimes used. Regular monitoring for fibrosis and liver disease progression is necessary to guide timing of liver transplant or other interventions.
Effective management of both conditions relies heavily on early detection, fibrosis staging, and coordinated care to prevent complications and improve outcomes. Steatohepatitis is often asymptomatic in the earlier stages, but abdominal pain and fatigue can be signs to seek medical help. If a person has abnormal liver function test results or imaging reveals fatty liver, they should consult a healthcare professional for an assessment of their risk of progressing to liver scarring. People concerned about their liver health or associated conditions such as type 2 diabetes should consult a healthcare professional to help detect steatohepatitis at an early stage.
It is possible to have both forms of steatohepatitis (BASH). Several health conditions can cause NASH, including obesity, type 2 diabetes, high blood pressure, dyslipidemia, polycystic ovary disease, obstructive sleep apnea, heart disease, chronic kidney disease, hepatitis C, rapid weight loss, certain toxins, and medications such as methotrexate, glucocorticoids, and synthetic estrogens. Preventing steatohepatitis involves drinking little or no alcohol, maintaining a moderate weight, eating a balanced diet, getting regular exercise, and avoiding risk factors such as obesity and excessive sugar and carbohydrate consumption.
Sources: [1], [3], [4], [5]
*[1] Afdhal N, et al. Hepatology. 2018;67(3):808-828. *[3] Younossi ZM, et al. Journal of Hepatology. 2016;65(1):198-210. *[4] Bugianesi E, et al. Gastroenterology. 2019;156(4):1001-1014.e1. *[5] Marion RA, et al. Hepatology. 2018;67(4):1429-1443.
- Excessive alcohol consumption can lead to a condition called Alcoholic Steatohepatitis (ASH), which primarily affects the liver and requires abstinence from alcohol.
- Nutritional support and management of alcohol use disorder (AUD) with behavioral therapy and pharmacologic treatments are essential for managing ASH.
- While monitoring for relapse is important post-liver transplantation for ASH patients, careful assessment of relapse risk and management of AUD is necessary.
- Nonalcoholic Steatohepatitis (NASH) is associated with conditions such as diabetes and requires lifestyle modifications, including weight loss and control of associated metabolic risk factors.
- Avoidance of alcohol is recommended for NASH patients, as it can accelerate fibrosis progression.
- Regular monitoring for fibrosis and liver disease progression is necessary for both ASH and NASH to guide timing of liver transplant or other interventions.
- Steatohepatitis is often asymptomatic in the earlier stages, but abdominal pain and fatigue can be signs to seek medical help.
- Early detection, fibrosis staging, and coordinated care are crucial for managing steatohepatitis and preventing complications.
- It is possible to have both forms of steatohepatitis, and several health conditions can cause NASH, including obesity, type 2 diabetes, and certain medications.
- Preventing steatohepatitis involves drinking little or no alcohol, maintaining a moderate weight, eating a balanced diet, getting regular exercise, and avoiding risk factors such as obesity and excessive sugar and carbohydrate consumption.
- Emerging pharmacologic treatments are under investigation for NASH, such as resmetirom, a thyroid hormone receptor beta agonist.
- People concerned about their liver health or associated conditions such as type 2 diabetes should consult a healthcare professional to help detect steatohepatitis at an early stage. Effective management of both conditions also involves therapy and treatments, fitness and exercise, nutrition, weight management, mental health, eye health, hearing, and skin care, as well as recognizing the potential benefits of supplements like CBD for managing associated symptoms and conditions.
