Diagnostic problems of non-alcoholic steatohepatitis in clinicopathological practice
Authors:
V. Bartoš 1; P. Slávik 2; D. Krkoška 3
Authors‘ workplace:
Ústav histológie a embryológie JLF UK v Martine
Vedúci: doc. MUDr. Adamkov M. CSc.
; Ústav patologickej anatómie JLF UK a MFN v Martine
Vedúci: prof. MUDr. Plank L. CSc.
2; Klinika infektológie a cestovnej medicíny JLF UK a MFN v Martine
Vedúci: prof. MUDr. Szilágyiová M. CSc.
3
Published in:
Prakt. Lék. 2008; 88(1): 14-17
Category:
Reviews
Overview
Non-alcoholic fatty liver disease (NAFLD) has recently become one of the most frequent and most important hepatic disorders throughout the world. This complex clinicopathological condition includes a spectrum of several nosological entities with distinct prognosis. The mildest form is a simple steatosis that can progress to steatohepatitis, steatofibrosis and can ultimately lead to cirrhosis or hepatocellular carcinoma. Although simple fatty liver is a relatively benign condition, non-alcoholic steatohepatitis (NASH) is much more dangerous and may have a very poor or unpredictable outcome. Furthermore, NAFLD is commonly without clinical manifestation and often discovered through incidentally elevated hepatic enzyme levels. Because it is an exclusion diagnosis, establishing of NASH can be difficult in clinical practice. It depends in great part on the veracity of the patient and his statement denying significant alcohol consumption. Liver biopsy is considered to be a “gold standard” diagnostic process, because it is of unquestioned value in determining the presence of steatosis or steatohepatitis. Fatty changes in liver parenchyma can be also detected by noninvasive imaging methods, however, microscopical examination is the only relatively reliable one to assess the morphological severity of this disease, and thus estimate a further prognosis. None of the clinical examinations has sufficient sensitivity and specificity for histological grading and staging of NAFLD, and cannot distinguish between simple steatosis and NASH with or without fibrosis. In addition to establishing the severity, histology permits the monitoring of disease progression and the response to therapy, as aminotransaminase levels may decrease during the course of the disease regardless of whether fibrosis progresses or improves. Finally, further studies on the pathogenesis of NASH may improve our understanding of the mechanisms involved in NAFLD progression, but may also lead to potentially novel therapeutic strategies to treat this frequent condition.
Key words:
non-alcoholic fatty liver disease, non-alcoholic steatohepatitis.
Sources
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