Choudhuri Gourdas, Shah Saumin, Kulkarni Anand, Jagtap Nitin, Gaonkar Pratyusha, Desai Akshay, Adhav Charles
Gastroenterology, Fortis Hospital Gurugram, Gurgaon, IND.
Gastroenterology, Gujarat Gastro and Vascular Hospital, Surat, IND.
Cureus. 2023 Aug 2;15(8):e42852. doi: 10.7759/cureus.42852. eCollection 2023 Aug.
Non-alcoholic steatohepatitis (NASH) is a subset of non-alcoholic fatty liver disease (NAFLD), which, apart from excess fat in the liver, may be characterised by some level of inflammatory infiltration and fibrogenesis, occasionally progressing to liver cirrhosis or hepatocellular carcinoma (HCC). The objective of the current review is to elucidate the rising prevalence, the role of microbiome and genetics in pathogenesis, diagnostic challenges, and novel treatment alternatives for NASH. Newer diagnostic techniques are being developed since using liver biopsy in a larger population is not a reasonable option and is primarily restricted to clinical research, at least in developing countries. Besides these technical challenges, another important factor leading to deviation from guideline practice is the lack of health insurance coverage in countries like India. It leads to reluctance on the part of physicians and patients to delay required tests to curb out-of-pocket expenditure. There is no cure for NASH, with liver transplantation remaining the last option for those who progress to end-stage liver disease (ESLD) or are detected with early-stage HCC. Thus, lifestyle modification remains the only viable option for many, but compliance and long-term adherence remain major challenges. In obese individuals, bariatric surgery and weight reduction have shown favourable results. In patients with less severe obesity, endoscopic bariatric metabolic therapies (EBMT) are rapidly emerging as less invasive therapies. However, access and acceptability remain poor for these weight reduction methods. Therefore, intense research is being conducted for potential newer drug classes with several agents currently in phase II or III of clinical development. Some of these have demonstrated promising results, such as a reduction in hepatic fat content, and attenuation of fibrosis with an acceptable tolerability profile in phase II studies. The developments in the management of NASH have been fairly encouraging. Further well-designed long-term prospective studies should be undertaken to generate evidence with definitive results.
非酒精性脂肪性肝炎（NASH）是非酒精性脂肪性肝病（NAFLD）的一个子集，除肝脏脂肪过多外，其特征可能还包括一定程度的炎症浸润和纤维化，偶尔会进展为肝硬化或肝细胞癌（HCC）。本综述的目的是阐明NASH患病率上升的情况、微生物群和遗传学在发病机制中的作用、诊断挑战以及新的治疗选择。由于在更大规模人群中进行肝活检不是一个合理的选择，且主要限于临床研究，至少在发展中国家是这样，因此正在开发更新的诊断技术。除了这些技术挑战外，导致偏离指南实践的另一个重要因素是印度等国家缺乏医疗保险覆盖。这导致医生和患者不愿推迟必要的检查以控制自付费用。NASH无法治愈，肝移植仍然是那些进展为终末期肝病（ESLD）或被检测出早期HCC患者的最后选择。因此，生活方式改变对许多人来说仍然是唯一可行的选择，但依从性和长期坚持仍然是主要挑战。在肥胖个体中，减肥手术和体重减轻已显示出良好效果。在肥胖程度较轻的患者中，内镜下减肥代谢疗法（EBMT）正迅速成为侵入性较小的疗法。然而，这些减肥方法的可及性和可接受性仍然很差。因此，正在对潜在的新型药物类别进行深入研究，目前有几种药物正处于临床开发的II期或III期。其中一些已显示出有前景的结果，例如在II期研究中肝脂肪含量降低，纤维化减轻，且耐受性良好。NASH管理方面的进展相当令人鼓舞。应进一步开展精心设计的长期前瞻性研究，以产生具有明确结果的证据。
