Diagnostic and therapeutic management of non-alcoholic steatohepatitis

Non-alcoholic fatty liver disease (NAFLD) represents the most common hepatic pathology in the Western World, progressing from non-alcoholic simple steatosis to non-alcoholic steatohepatitis (NASH), with or without fibrosis. It has an established connection with other comorbidities such as obesity, insulin resistance, type 2 diabetes mellitus and dyslipidemia. Clinically, patients are oligosymptomatic. Mild to moderate increase in serum liver enzymes can be found in NAFLD. Some studies demonstrated a very promising biochemical diagnosing procedure using adipokines and serum proinflammatory cytokines. Imagistic diagnosis consists of ultrasonography, computed tomography and magnetic resonance imaging. Treatment of NAFLD is complex and starts with optimizing the lifestyle through exercise and diet. Pharmacologic therapy in NASH is indicated in patients with comorbidities or with high risk of advanced fibrosis. It includes: insulin sensitizers, antioxidants, lipid lowering drugs, N-3 polyunsaturated fatty acids, ursodeoxycholic acid, pentoxifylline, probiotics and synbiotics. Surgical forms of treatment are bariatric surgery and liver transplantation.