Patient Care

Non-alcoholic Steatohepatitis (NASH)

What is Non-alcoholic Steatohepatitis (NASH)?

NASH is a condition where there is fat accumulation and inflammation in the liver. It occurs in people who do not drink alcohol. The exact cause is unknown.

However, it is seen with increased frequency in people with certain medical conditions such as diabetes mellitus, obesity and high cholesterol.

NASH is typically a chronic condition (i.e. it persists for many years). Most people with this condition will not develop serious liver problems. On the other hand, the condition can lead to progressive scarring and cirrhosis in others. It is difficult to predict the natural course of NASH in individual patients.

What are the signs & symptoms of NASH?

Most people with NASH have no symptoms. The condition is usually picked up during routine health screening when the liver function tests are abnormal.

How is NASH diagnosed?

You should seek advice from a liver doctor (hepatologist) to confirm the diagnosis and also on how to manage the condition.

Liver function tests usually show an elevated ALT or AST. Fatty infiltration of the liver is also seen on ultrasound of the abdomen. It is important to exclude viral hepatitis B and C, as well as other metabolic and autoimmune causes of liver disease through blood tests.

The most accurate test for the diagnosis of NASH is a liver biopsy. The biopsy will also help to determine the stage of the disease (i.e. whether cirrhosis is present).

Who is at risk of NASH?

People at risk of NASH are those who are overweight (BMI exceeds 23 for Asians and 25 for Caucasians). Individuals with diabetes mellitus, gout, hypertension, and hyperlipidemia are also at risk of developing NASH.

What are the treatment options for NASH?

At this time, there are no treatments that can cure NASH. The main goal of treatment is to control the conditions that are associated with NASH, such as obesity and hyperlipidemia. Several experimental treatments are being studied, but none can be routinely recommended.

Lifestyle measures such as weight reduction are the main stay of treatment but should be done gradually as rapid weight loss has been associated with worsening of liver disease.

The typical course of NASH is still being studied. About a third may progress to fibrosis and about 20% will develop cirrhosis over a period of 9 years.

normal liver biopsy

Picture of normal liver biopsy

NASH liver biopsy

Picture of NASH liver biopsy

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Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

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