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World J Gastroenterol. Oct 21, 2014; 20(39): 14219-14229
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14219
Non-alcoholic fatty liver disease: What has changed in the treatment since the beginning?
Bülent Baran, Filiz Akyüz
Bülent Baran, Filiz Akyüz, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Capa, 34093 Istanbul, Turkey
Author contributions: Baran B and Akyuz F contributed equally to this work; Baran B performed the literature search and wrote the manuscript; Akyuz F was responsible for critical revision of the manuscript for important intellectual content.
Correspondence to: Filiz Akyuz, MD, Professor, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Capa, 34093 Istanbul, Turkey. filizakyuz@hotmail.com
Telephone: +90-212-4142000 Fax: +90-212-6319743
Received: February 25, 2014
Revised: April 22, 2014
Accepted: May 25, 2014
Published online: October 21, 2014
Processing time: 237 Days and 18 Hours
Abstract

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term to describe the entire spectrum of this common liver disease. In patients with NAFLD, especially those with non-alcoholic steatohepatitis (NASH), most often have one or more components of the metabolic syndrome, but this is not universal. Although most patients with NAFLD share many clinical features, only a subset of patients develops significant liver inflammation and progressive fibrosis. On the other hand, not all patients with NASH exhibit insulin resistance. NASH can be seen in patients who are lean and have no identifiable risk factors. Many clinical studies have tried numerous drugs and alternative medicine, however, investigators have failed to identify a safe and effective therapy for patients with NASH. As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.

Keywords: Non-alcoholic steatohepatitis; Pathogenesis; Inflammation; Fibrosis; Life-style changes; Pharmacologic treatment

Core tip: Many clinical studies have tried numerous drugs and alternative medicine, but investigators have failed to identify a safe and effective therapy for patients with non-alcoholic steatohepatitis (NASH). As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.