Nonalcoholic Steatohepatitis

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What is Nonalcoholic steatohepatitis  (NASH)?

Nonalcoholic Steatohepatitis (NASH) is an advanced form of Nonalcoholic Fatty Liver Disease (NAFLD) characterized by liver inflammation and damage in addition to fat buildup. Unlike simple fatty liver (steatosis), NASH involves inflammation and scarring (fibrosis), which can progress to cirrhosis or liver cancer over time.

NASH typically occurs in individuals who drink little or no alcohol but have metabolic risk factors such as obesity, insulin resistance, high cholesterol, or type 2 diabetes. Because NASH often develops silently, many people are unaware they have it until significant liver damage has occurred.

Is Nonalcoholic steatohepatitis  common?

NASH affects about 3–5% of adults worldwide and is more common in people with obesity or diabetes. It is currently one of the leading causes of liver transplantation in the United States and is expected to become the most common cause in the coming years.

Can Nonalcoholic steatohepatitis  be cured?

There is no specific cure for NASH yet, but its progression can often be slowed or even reversed with early intervention. Lifestyle changes, weight loss, and medical management of associated conditions like diabetes and high cholesterol can significantly improve liver health.

Causes

What causes Nonalcoholic steatohepatitis ?

NASH develops when the liver accumulates excess fat that triggers inflammation and cell injury. The exact cause isn’t fully understood, but several factors contribute:

  • Obesity – especially central (abdominal) obesity
  • Insulin resistance and type 2 diabetes
  • High cholesterol and triglycerides
  • Poor diet – high in sugar, refined carbs, and saturated fats
  • Sedentary lifestyle
  • Genetics – family history of fatty liver or metabolic syndrome
  • Hormonal conditions – polycystic ovary syndrome (PCOS)
  • Medications – such as corticosteroids, tamoxifen, or certain antivirals

With Insurance

Hepatology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$169
Initial Visit
$109
Follow Up

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Symptoms

What are the symptoms of Nonalcoholic steatohepatitis?

NASH often causes no symptoms in early stages. As the disease progresses, patients may notice:

  • Persistent fatigue or weakness
  • Pain or discomfort in the upper right abdomen
  • Unexplained weight loss
  • Enlarged liver (hepatomegaly)
  • Jaundice (yellowing of skin or eyes) in advanced stages
  • Swelling in legs or abdomen (edema, ascites)
  • Confusion or difficulty concentrating (signs of hepatic encephalopathy in late disease)

Because symptoms are subtle or absent, many cases are discovered incidentally through blood tests or imaging for other conditions.

Diagnosis

How is Nonalcoholic steatohepatitis diagnosed?

Diagnosis requires identifying both fat buildup and inflammation in the liver:

  • Medical history and exam – to rule out alcohol use and other causes of liver disease
  • Blood tests – elevated liver enzymes (ALT, AST) may suggest liver inflammation
  • Imaging tests – ultrasound, MRI, or FibroScan can detect fat and fibrosis
  • Liver biopsy – the gold standard to confirm inflammation, cell injury, and scarring (distinguishes NASH from simple fatty liver)
  • Non-invasive fibrosis tests – may estimate liver stiffness and stage of fibrosis

Treatment

How is Nonalcoholic steatohepatitis  treated?

The goal of treatment is to reduce liver fat, inflammation, and scarring while addressing metabolic risk factors.

Lifestyle and dietary management:

  • Weight loss: Losing 7–10% of body weight can reduce inflammation and fibrosis.
  • Healthy diet: Emphasize a Mediterranean or DASH-style diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
  • Exercise: At least 150 minutes per week of moderate-intensity activity.
  • Avoid alcohol and limit sugary or processed foods.

Medical management:

  • Control of diabetes, cholesterol, and blood pressure
  • Vitamin E: Vitamin E may be used in select cases under specialist supervision.
  • Pioglitazone (a diabetes medication) Pioglitazone may be used in select cases under specialist supervision.
  • Emerging therapies: New drugs targeting inflammation, fibrosis, and metabolism are under study.

Procedures:

  • Bariatric surgery may be an option for patients with severe obesity and liver disease.
  • Liver transplantation may be required in advanced or cirrhotic cases.

With early detection, consistent lifestyle changes, and medical management, progression to cirrhosis can often be prevented.

References

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Affordable – with or without insurance

With Insurance

Hepatology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$169
Initial Visit
$109
Follow Up

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