1Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine, Stanford, CA.
2Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, Oakland, CA.
3Division of Gastroenterology, San Antonio Military Medical Center, Fort Sam Houston, TX. Electronic address: Stephen.firstname.lastname@example.org.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of abnormal serum aminotransferase levels both in developed and developing countries. Patients with nonalcoholic steatohepatitis (NASH), a subset of NAFLD are at risk for progressive liver disease and in need of effective treatment options. A practical approach may be pursued by identifying patients with NAFLD with the highest likelihood for histologic evidence of NASH. Despite decades of clinical trials, no single treatment can be recommended to all patients with NASH. Importantly, there is no evidence that pioglitazone or vitamin E improves fibrosis. Bariatric surgeries may improve hepatic histology in morbidly obese patients with NASH, although randomized clinical trials are lacking. Currently, NASH is the second leading etiology of liver disease among adults awaiting liver transplantation (LT) in the U.S. The primary and secondary prevention of NAFLD may require aggressive strategies for managing obesity, diabetes and metabolic syndrome.