Non-alcoholic steatohepatitis (NASH)

Non-alcoholic steatohepatitis (NASH) is an increasingly common cause of persistently abnormal liver tests. Establishing a diagnosis of NASH requires the secure exclusion of alcohol abuse and hepatitis C as an alternate cause of liver injury. The gold standard of diagnosis is liver biopsy. Unfortunately, NASH, although a common entity, is without a satisfactory treatment. Weight reduction, optimum blood glucose control, and elimination of medications implicated in causing the disorder are sensible first steps in treatment. Drug therapy should not be used unless there is histologic evidence of necro-inflammatory injury and/or fibrosis. Ursodeoxycholic acid (UDCA) has been reported to be of benefit in non-controlled trials and anecdotal case reports. Our approach is to use ursodeoxycholic acid in a dose of 15 mg/kg, and to monitor serial liver enzyme tests. Predictable normalization of liver tests often results, but relentless progression of liver injury can occur in the face of consistently normal liver tests. Close follow-up is mandatory after establishing a diagnosis of NASH. Newer, more effective drugs are needed to treat NASH in a controlled trial environment.