Steatohepatitis: Difference between revisions

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==Treatment==
==Treatment==
[[Vitamin E]], but not [[pioglitazone]], may improve liver histology in a [[randomized controlled trial]] of 247 patients who did not have [[diabetes]].<ref name="pmid17135584">{{cite journal| author=Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J et al.| title=A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 22 | pages= 2297-307 | pmid=17135584
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=17135584 | doi=10.1056/NEJMoa060326 }} </ref>


Previously, [[pioglitazone]], a [[thiazolidinedione]] derivative normally used for treating [[diabetes mellitus type 2]], can improve nonalcoholic steatohepatitis in patients with [[impaired glucose tolerance]] or [[diabetes mellitus type 2]] according to a preliminary [[randomized controlled trial]] of 55 patients.<ref name="pmid17135584">{{cite journal| author=Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J et al.| title=A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 22 | pages= 2297-307 | pmid=17135584  
Weight loss may help.<ref name="pmid19827166">{{cite journal| author=Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR et al.| title=Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. | journal=Hepatology | year= 2010 | volume= 51 | issue= 1 | pages= 121-9 | pmid=19827166
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17135584 | doi=10.1056/NEJMoa060326 }}</ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19827166 | doi=10.1002/hep.23276 | pmc=PMC2799538 }} </ref>
 
===Antioxidants===
[[Vitamin E]], an [[antioxidant]], may improve liver histology in a [[randomized controlled trial]] of 247 patients who did not have [[diabetes]].<ref name="pmid20427778">{{cite journal| author=Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM et al.| title=Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. | journal=N Engl J Med | year= 2010 | volume=  | issue=  | pages=  | pmid=20427778
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20427778 | doi=10.1056/NEJMoa0907929 }} </ref>
 
===Cholesterol reduction===
[[Simvastatin]] did not help in a pilot study.<ref name="pmid19448566">{{cite journal| author=Nelson A, Torres DM, Morgan AE, Fincke C, Harrison SA| title=A pilot study using simvastatin in the treatment of nonalcoholic steatohepatitis: A randomized placebo-controlled trial. | journal=J Clin Gastroenterol | year= 2009 Nov-Dec | volume= 43 | issue= 10 | pages= 990-4 | pmid=19448566
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19448566 | doi=10.1097/MCG.0b013e31819c392e }} </ref>
 
===Increasing insulin sensitivity===
[[Thiazolidinedione]]  derivatives, normally used for treating [[diabetes mellitus type 2]] by  increasing sensitivity to [[insulin]], have been studied for the treatment of nonalcoholic  steatohepatitis.
 
[[Pioglitazone]] did not improve liver histology in a [[randomized  controlled trial]] of  247 patients who did not have [[diabetes]].<ref name="pmid20427778">{{cite journal|  author=Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass  NM et al.| title=Pioglitazone, Vitamin E, or Placebo for Nonalcoholic  Steatohepatitis. | journal=N Engl J Med | year= 2010 | volume=  |  issue=  | pages=  | pmid=20427778
|  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20427778  | doi=10.1056/NEJMoa0907929 }} </ref>
 
Previously, [[pioglitazone]] improved nonalcoholic steatohepatitis in patients with [[impaired glucose tolerance]] or [[diabetes mellitus type 2]] according to a preliminary [[randomized controlled trial]] of 55 patients.<ref name="pmid17135584">{{cite journal| author=Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J et al.| title=A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 22 | pages= 2297-307 | pmid=17135584  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17135584 | doi=10.1056/NEJMoa060326 }}</ref> Also, [[rosiglitazone]] improved histology and liver [[transaminase]]s in a trial 63 patients that excluded patients taking insulin (30% had diabetes and were taking other drugs)<ref name="pmid18503774">{{cite journal| author=Ratziu V, Giral P, Jacqueminet S, Charlotte F, Hartemann-Heurtier A, Serfaty L et al.| title=Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial. | journal=Gastroenterology | year= 2008 | volume= 135 | issue= 1 | pages= 100-10 | pmid=18503774
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18503774 | doi=10.1053/j.gastro.2008.03.078 }} </ref>, with longer treatment of 44 patients<ref name="pmid19877169">{{cite journal| author=Ratziu V, Charlotte F, Bernhardt C, Giral P, Halbron M, Lenaour G et al.| title=Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial. | journal=Hepatology | year= 2010 | volume= 51 | issue= 2 | pages= 445-53 | pmid=19877169
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19877169 | doi=10.1002/hep.23270 }} </ref>.
 
===Surgery===
While [[bariatric surgery]] would seem effective, it has not been studied.<ref name="pmid20091629">{{cite journal| author=Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, Mendez-Sanchez N, Lizardi-Cervera J, Uribe M| title=Bariatric surgery for non-alcoholic steatohepatitis in obese patients. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 1 | pages= CD007340 | pmid=20091629
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20091629 | doi=10.1002/14651858.CD007340.pub2 }} </ref>


==References==
==References==
<references/>
<references/>

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In medicine, steatohepatitis is a liver disease characterized by fatty liver and lobular hepatitis.[1]

Hepatitis, inflammation of the liver, can be detected by liver biopsy, or can be suggested by elevated blood levels of tumor necrosis factor - alpha (TNF-alpha) and transforming growth factor beta (TGF-beta).[2]

Classification

Alcoholic steatohepatitis

Nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is associated with obesity, diabetes mellitus, or hyperlipidemia.[1] NASH may be caused by the single-nucleotide polymorphisms rs2854116 (c.455T>C) and rs2854117 (c.482C>T) of apolipoprotein C-III which are also associated with insulin resistance and hypertriglyceridemia.[3]

Treatment

Weight loss may help.[4]

Antioxidants

Vitamin E, an antioxidant, may improve liver histology in a randomized controlled trial of 247 patients who did not have diabetes.[5]

Cholesterol reduction

Simvastatin did not help in a pilot study.[6]

Increasing insulin sensitivity

Thiazolidinedione derivatives, normally used for treating diabetes mellitus type 2 by increasing sensitivity to insulin, have been studied for the treatment of nonalcoholic steatohepatitis.

Pioglitazone did not improve liver histology in a randomized controlled trial of 247 patients who did not have diabetes.[5]

Previously, pioglitazone improved nonalcoholic steatohepatitis in patients with impaired glucose tolerance or diabetes mellitus type 2 according to a preliminary randomized controlled trial of 55 patients.[2] Also, rosiglitazone improved histology and liver transaminases in a trial 63 patients that excluded patients taking insulin (30% had diabetes and were taking other drugs)[7], with longer treatment of 44 patients[8].

Surgery

While bariatric surgery would seem effective, it has not been studied.[9]

References

  1. ↑ 1.0 1.1 Sheth SG, Gordon FD, Chopra S (1997). "Nonalcoholic steatohepatitis.". Ann Intern Med 126 (2): 137-45. PMID 9005748.
  2. ↑ 2.0 2.1 Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J et al. (2006). "A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis.". N Engl J Med 355 (22): 2297-307. DOI:10.1056/NEJMoa060326. PMID 17135584. Research Blogging. Cite error: Invalid <ref> tag; name "pmid17135584" defined multiple times with different content
  3. ↑ Petersen KF, Dufour S, Hariri A, Nelson-Williams C, Foo JN, Zhang XM et al. (2010). "Apolipoprotein C3 gene variants in nonalcoholic fatty liver disease.". N Engl J Med 362 (12): 1082-9. DOI:10.1056/NEJMoa0907295. PMID 20335584. Research Blogging.
  4. ↑ Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR et al. (2010). "Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis.". Hepatology 51 (1): 121-9. DOI:10.1002/hep.23276. PMID 19827166. PMC PMC2799538. Research Blogging.
  5. ↑ 5.0 5.1 Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM et al. (2010). "Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis.". N Engl J Med. DOI:10.1056/NEJMoa0907929. PMID 20427778. Research Blogging. Cite error: Invalid <ref> tag; name "pmid20427778" defined multiple times with different content
  6. ↑ Nelson A, Torres DM, Morgan AE, Fincke C, Harrison SA (2009 Nov-Dec). "A pilot study using simvastatin in the treatment of nonalcoholic steatohepatitis: A randomized placebo-controlled trial.". J Clin Gastroenterol 43 (10): 990-4. DOI:10.1097/MCG.0b013e31819c392e. PMID 19448566. Research Blogging.
  7. ↑ Ratziu V, Giral P, Jacqueminet S, Charlotte F, Hartemann-Heurtier A, Serfaty L et al. (2008). "Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial.". Gastroenterology 135 (1): 100-10. DOI:10.1053/j.gastro.2008.03.078. PMID 18503774. Research Blogging.
  8. ↑ Ratziu V, Charlotte F, Bernhardt C, Giral P, Halbron M, Lenaour G et al. (2010). "Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial.". Hepatology 51 (2): 445-53. DOI:10.1002/hep.23270. PMID 19877169. Research Blogging.
  9. ↑ Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, Mendez-Sanchez N, Lizardi-Cervera J, Uribe M (2010). "Bariatric surgery for non-alcoholic steatohepatitis in obese patients.". Cochrane Database Syst Rev (1): CD007340. DOI:10.1002/14651858.CD007340.pub2. PMID 20091629. Research Blogging.
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