Get your own Free Home PageNon-alcoholic steatohepatitis and GB virus-C/hepatitis G virus infection: is there a casual relationship? [editorial; comment]
Kiyosawa K; Intern Med, 1997 Apr, 36:4, 236-7
REVIEW: NONALCOHOLIC STEATOHEPATITIS.
Ludwig J; McGill DB; Lindor KD; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA. J Gastroenterol Hepatol, 1997 May, 12:5, 398-403
Nonalcoholic steatohepatitis (NASH) is a reasonably
well-defined clinicopathological entity; it has been reported
more commonly in women than in men or children of both sexes and
it appears to be most closely associated with obesity, diabetes
mellitus and related abnormalities, such as hyperlipidaemia and
hyperglycaemia. However, the association with female gender, obesity
and diabetes may not be as close as suggested by the literature
and an underlying condition cannot be discerned in all cases.
The natural history of the disease is poorly understood; the
associated biopsy features span a wide spectrum, reaching from
uncomplicated, clinically non-progressive fatty liver (not NASH
in a strict sense) to a slowly progressive fatty liver with inflammation
and fibrosis, to steatohepatitis with submassive hepatic necrosis,
which has a subfulminant course and is often fatal. Non-progressive
fatty liver appears to be very common but is of little clinical
importance. The slowly progressive form of the disease represents
NASH as encountered by most clinicians and pathologists. It is
a common liver disease in current practice; patients may present
with cirrhosis and even HCC arising from steatohepatitic cirrhosis.
Subfulminant NASH has become exceedingly rare because many clinicians
are now aware of the hazards of sudden weight loss, particularly
in morbidly obese patients. Treatment options for NASH are still
limited. The promotion of gradual weight loss in obese patients
is the most widely recommended therapy but, unfortunately, this
is very difficult to achieve. Avoidance of precipitous weight
loss and careful control of diabetes mellitus are important and
undisputed parts of patient management. Administration of UDCA
as a treatment of NASH is still under study; it may be effective
in some patients. The treatment of established steatohepatitic
cirrhosis does not differ substantially from that of other types
of cirrhosis and includes orthotopic liver transplantation.
NONALCOHOLIC STEATOHEPATITIS: MAYO CLINIC EXPERIENCES WITH A HITHERTO UNNAMED DISEASE.
Ludwig J; Viggiano TR; McGill DB; Oh BJ; Mayo Clin Proc, 1980 Jul, 55:7, 434-8
Nonalcoholic steatohepatitis is a poorly understood and hitherto unnamed liver disease that histologically mimics alcoholic hepatitis and that also may progress to cirrhosis. Described here are findings in 20 patients with nonalcoholic steatohepatitis of unknown cause. The biopsy specimens were characterized by the presence of striking fatty changes with evidence of lobular hepatitis, focal necroses with mixed inflammatory infiltrates, and, in most instances, Mallory bodies; Evidence of fibrosis was found in most specimens, and cirrhosis was diagnosed in biopsy tissue from three patients. The disease was more common in women. Most patients were moderately obese, and many had obesity-associated diseases, such as diabetes mellitus and cholelithiasis. Presence of hepatomegaly and mild abnormalities of liver function were common clinical findings. Currently, we know of no effective therapy.
HOW IS NONALCOHOLIC STEATOHEPATITIS DIAGNOSED,
Many NASH patients are unaware of their condition because they do not exhibit any symptoms. In most cases NASH results in a slight increase in liver enzyme tests, as do other forms of liver disease. In diagnosing NASH, the physician will first eliminate the other possible causes of chronic liver disease. The diagnosis must be confirmed by liver biopsy.
Previously, physicians believed that NASH was a benign disorder
which did not progress or was slow in developing. Recent studies
and the experience of physicians indicate that NASH can result
in the development of fibrous tissue in the liver for up to 40%
of patients or scarring of the liver (cirrhosis) in 5-10% of patients.
It is not certain why some NASH patients will progress to this
serious form of chronic liver disease while others will not. Studies
report that the progression to fibrosis or cirrhosis for NASH
patients is variable but can occasionally occur in less than 10
years. Many patients with NASH will show an increase of certain
iron proteins (ferritin) in their blood, but whether this relates
to any injury to their liver is unknown.
VS. HISTOLOGIC ABNORMALITIES IN CHC,
If clotting parameters permit or the transjugular biopsy route
is available, patients with chronic HCV infections should be biopsied
in order to document the extent of disease, the likelihood of
progression to cirrhosis and in rare instances, to exclude the
presence and/or establish the contribution of co-existing liver
diseases. In addition to the typical features of chronic hepatitis
seen with most viral and non viral causes of chronic liver disease,
there are three useful characteristic, but not diagnostic features
of chronic HCV infections; steatosis (present in 30-70%), lymphoid
aggregates (45-80%), and bile duct damage (20-90%).
AND ABNORMALITIES ASSOCIATED WITH HGV
Clinical implications of GBV-C/HGV infection in patients with
rising-dbl-quote-leftHCV-related' chronic hepatitis - J. Hepatology,
June97,Raffaella Francesconi, Fabrizio Giostra, Giorgio Ballardini,
Aldo Manzin,
It does not worsen the HCV-related disease (ALT levels and histological activity) and does not significantly interfere with HCV infection, as explored by the number of hepatocytes positive for HCV antigens. The amount of steatosis (mean score) was shown to be higher in GBV-C/HGV+ patients. A virological follow up was performed in 17 interferon-treated GBV-C/HGV+ patients On the whole, GBV-C/HGV seems to be as sensitive to IFN treatment as HCV, but recurrence after withdrawal is more frequent. In spite of this, ALT levels often remain normal after treatment withdrawal.
TWO CASES FROM THE SPECTRUM OF NONALCOHOLIC STEATOHEPATITIS
Abdelmalek M; Ludwig J; Lindor KD; Division of Gastroenterology and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. (J Clin Gastroenterol, 1995 Mar)
Nonalcoholic steatohepatitis is a poorly understood disease that mimics alcoholic liver disease histologically. Its natural history is not well defined, although gradual progression to cirrhosis has been described. Most patients with this condition have been obese, with or without associated diabetes or hyperlipidemia. No known effective treatment exists for nonalcoholic steatohepatitis, although weight loss may have a beneficial effect. We report two cases of nonalcoholic steatohepatitis. One patient with well-established nonalcoholic steatohepatitis had cirrhosis with a complete loss of fat on subsequent liver biopsy despite a gain in weight, simulating cryptogenic cirrhosis. In another patient, the condition improved after use of ursodeoxycholic acid; this agent may be a potential therapeutic agent for the treatment of nonalcoholic steatohepatitis. We believe these two cases represent the spectrum of this condition: on the one end is a progressive liver disease that in some instances may be a cause of cryptogenic cirrhosis; at the other end, a potentially treatable liver condition.
GLUTATHIONE IN THE TREATMENT OF CHRONIC FATTY LIVER DISEASES
Dentico P; Volpe A; Buongiorno R; Grattagliano I; Altomare E; Tantimonaco G; Scotto G; Sacco R; Schiraldi O; Istituto Policattedra, Università, Bari. Recenti Prog Med( in Italian ), 1995 Jul-Aug, 86:7-8, 290-3
In chronic steatosic liver disease, alcohol or non-alcohol related
or HBV, HCV, HDV associated, a reduction in hepatic glutathione
and, consequently, in the detoxifying effects of hepatocytes is
observed. Intravenous administration of high dose glutathione
in patients with chronic steatosic liver disease has shown that
glutathione significantly improves the rate of some hepatic tests
(bilirubin, GOT, GPT, GT) even several months after treatment
interruption. Further confirmation of the efficacy of GSH treatment
is provided by the reduction of malondialdehyde, a marker of hepatic
cell damage. The optimal results obtained in patients receiving
1800 mg/die/i.v. advocate the use of this high dosage.
PATHOGENESIS-SCREENING TESTS FOR LIVER DYSFUNCTION IN THE ASYMPTOMATIC PATIENTS WITH ELEVATED ALT VALUES AND THEIR DIAGNOSTIC EFFICACIES IN PRIMARY CARE MEDICINE
Takemura Y; Kobayashi H; Kamachi M; Sekiguchi S; Shioikari M; Tamura M;Department of Laboratory Medicine, National Defense Medical College, Tokorozawa, Japan. Rinsho Byori( in Japanese ), 1996 Mar, 44:3, 261-6
We have evaluated the diagnostic efficacies of ultrasonography and hepatitis C virus (HCV) antibody measurement to differentiate pathogenesis of liver dysfunction in the asymptomatic adults with elevated ALT value. Among 4256 visitors to PL Tokyo Health Control Center for their health examination, 463 cases (11%) showed abnormal liver function including elevation of ALT value. Ultrasonography and HCV antibody measurement using the second generation reagent had been applied to 362 cases in order to screen the etiology of liver dysfunction. The ultrasonography succeeded to establish the diagnosis of fatty liver in 137 cases (38%) and 41 cases (11%) demonstrated positive HCV antibody. There were 4 cases with positive HBs antigen, however, it was found that their abnormal liver function was attributed to other etiology such as fatty liver and alcoholic liver dysfunction rather than chronic type B hepatitis. HCV antibody-positive cases showed higher levels of total protein, ZTT, AST, ALT, and lower levels of albumin, A/G, total cholesterol, triglyceride, gamma-GT and cholinesterase value than other cases. HCV antibody titers were not correlated to hepatic parenchymal damage estimated by ALT or cholinesterase value. Only a little correlation was observed between HCV antibody titers and HCV-RNA amounts determined by the competitive reverse transcription-polymerase chain reaction (RT-PCR) method. These results indicate sufficient diagnostic efficacies of ultrasonography and HCV antibody measurement for a pathogenesis differentiation in the asymptomatic patients with liver dysfunction, and these examinations should be employed as the first-step screening tests for the etiology determination of liver diseases in the primary care medicine.
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