From the Guidelines
The proper name for cirrhosis due to NASH is NASH cirrhosis or nonalcoholic steatohepatitis-related cirrhosis. This condition represents the advanced stage of nonalcoholic fatty liver disease (NAFLD) where inflammation and fibrosis have progressed to cirrhosis, as indicated by guidelines for liver transplantation in patients with non-alcoholic steatohepatitis 1. NASH cirrhosis develops when fat accumulation in the liver (steatosis) leads to inflammation, hepatocyte injury, and eventually extensive scarring that disrupts normal liver architecture and function. Some key points to consider in the diagnosis and management of NASH cirrhosis include:
- Criteria for diagnosis of NASH-related cirrhosis should include an established clinical and histological diagnosis of NASH on liver biopsy, or a histological diagnosis of cryptogenic cirrhosis with a clinical phenotype compatible with underlying NASH, as defined by the presence of three or more components of the metabolic syndrome prior to liver transplant (LT) 1.
- The progression from NAFLD to NASH and ultimately to cirrhosis typically occurs over many years, with some patients remaining asymptomatic until advanced liver disease develops.
- Management focuses on treating the underlying metabolic conditions, weight loss, exercise, and monitoring for complications of cirrhosis such as portal hypertension, ascites, and hepatocellular carcinoma.
- NASH may be the underlying cause of many cases of cryptogenic cirrhosis, particularly among older diabetic women, and there is evidence for an increased risk of HCC in patients with NASH 1.
From the Research
Definition of NASH Cirrhosis
- NASH cirrhosis is a type of cirrhosis caused by nonalcoholic steatohepatitis (NASH) 2, 3, 4, 5, 6.
- NASH is a condition characterized by inflammation and fat accumulation in the liver, which can lead to fibrosis and cirrhosis 3, 4.
- The proper name for cirrhosis due to NASH is NASH cirrhosis or cryptogenic cirrhosis, as the exact cause of the liver damage is not always clear 5.
Characteristics of NASH Cirrhosis
- NASH cirrhosis is often associated with metabolic syndrome, insulin resistance, and obesity 2, 4, 6.
- Patients with NASH cirrhosis may have a higher risk of developing hepatocellular carcinoma and liver failure 3, 5.
- The diagnosis of NASH cirrhosis is typically made through a combination of liver biopsy, imaging studies, and laboratory tests 2, 4, 6.
Treatment and Management
- Treatment for NASH cirrhosis typically involves lifestyle modifications, such as weight loss and exercise, as well as medications to manage related conditions like diabetes and high blood pressure 2, 3, 4, 6.
- Vitamin E and pioglitazone have been shown to improve liver histology and insulin sensitivity in patients with NASH 2, 3, 4, 6.
- Liver transplantation may be considered in advanced cases of NASH cirrhosis 5.