Overview of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis Management

Abstract

The number of patients with chronic liver diseases is expected to decline due to progress in antivirus therapy, including direct-acting antivirals for hepatitis C and nucleot(s)ide analogues for hepatitis B. On the other hand, the number of patients with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) in the setting of metabolic syndrome has been increasing worldwide. Hepatocellular carcinoma (HCC) arises in the setting of chronic hepatic inflammation and liver cirrhosis associated with NAFLD/NASH. However, the detailed clinical features of NAFLD/NASH and NAFLD/NASH-derived HCC prevalence have not yet been fully elucidated as there are two major problems in diagnosing definitive NAFLD/NASH: it is difficult to evaluate past alcoholic consumption history precisely and to obtain certain pathologic findings from all patients with fatty liver. Although previous studies clarified some of the genetic and pathophysiological aspects of NAFLD/NASH, basic knowledge of NAFLD/NASH mechanisms remains insufficient and the methods for predicting the risk of tumorigenesis and effective therapy for NAFLD/NASH are not well defined. The treatment of NAFLD/NASH comprises changes in lifestyle including eating habits and exercise leading to weight loss, and drug intake such as vitamin E. A number of new drugs for NAFLD/NASH patients have been under trial. Additional larger-scale studies are required to elucidate fully the clinical and basic landscape of NAFLD-HCC. This paper gives an overview of NAFLD/NASH management based on the most recent findings.