NASH: evaluation and treatment

Published on October 29, 2015 Updated on August 29, 2019   50 min

Other Talks in the Therapeutic Area: Cardiovascular & Metabolic

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Good morning. My name is Arun Sanyal. I'm a professor of medicine at Virginia Commonwealth University. And today, we will talk about non-alcoholic steatohepatitis and provide an update on diagnostics and therapy. That slide shows my conflicts of interest which are available for anyone who would like to review them.
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Non-alcoholic steatohepatitis is part of a spectrum of liver disease
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where there is excessive fat in the liver. In this disease, there is a spectrum of histology where at one end, patients just have fat in the liver but not much else, and that is called a fatty liver. Or they can have a lesion called steatohepatitis. Steatohepatitis is not just fat and inflammation, but it involves a specific histologic entity called cytologic ballooning as shown where you can see an arrow. These cells are ballooned, as you can see, and their cytoplasm has a vacuolated appearance. There is perinuclear condensation of cytoplasm, and sometimes you get accumulation of intracellular eosinophilic inclusions. And these are called Mallory bodies. There is, in addition, scattered inflammation, which is mainly lobular, but can also involve the portal areas. And then there is a special form of fibrosis called perisinusoidal fibrosis. Now the reason we are concerned about non-alcoholic steatohepatitis is because of its risk of progression to cirrhosis and to hepatocellular carcinoma. Let me give you a brief overview of the health burden associated with this condition. Roughly 30 percent of the adult population in the western world has excess fat in their liver, i.e. a fatty liver. Of these, about a quarter have steatohepatitis.