Gut and Gastroenterology

Non-Alcoholic Fatty Liver: Current Management and Future Trends

Author(s): Achuthan Sourianarayanane, Suryanarayana Reddy Challa

Non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease and is becoming recognized as a global health problem. It is a spectrum of liver disease with progression from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. Progression of the disease is mediated through different inflammatory pathways with subsequent fibrosis resulting in cirrhosis and its related complications. The condition seems to be more prevalent among patients with type II diabetes mellitus (70%) and (90%) morbid obesity. NAFLD is now considered as a hepatic component of the metabolic syndrome because of its close association with obesity, insulin resistance (IR), and type II diabetes. Cardiovascular related deaths are common among patients with NAFLD and with the onset of NASH and cirrhosis they have increased liver-related mortality.
Despite intense research, therapy for NAFLD always remains unmet medical attention. Interventions aim at different aspects of presumed risks for hepatic steatosis (obesity, insulin resistance, and hypertension). Lifestyle modifications are proven to be useful not only in the prevention and control of the disease but also in the reduction of associated comorbidities, with promising results. Long-term adherence and sustained improvement are not, however, documented in most subjects. Targeting therapies aiming at mitigating specific pathways of NAFLD along with cellular and molecular events at various stages of the pathogenesis are attempted with varying degree of success. Many longitudinal studies have shown that the presence and severity (stage)of fibrosis on liver histology correlates with increased risk of all-cause as well as liver-related mortality in patients with NAFLD. Specific treatments aimed at this aspect are also evaluated. This review summarizes the current treatment options in the management of NASH and therapies which are being actively evaluated (including phase II/III clinical trials) with promising data.

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