title: Comparison of clinical, biochemical and histological features of alcoholic steatohepatitis and non-alcoholic steatohepatitis in Asian Indian patients.
abstract: BACKGROUND
  Alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH) are significant forms of liver disease and may progress to end-stage liver disease, cirrhosis and potentially malignant complications. The most difficult aspect of establishing a diagnosis of NASH is distinguishing it from ASH. Laboratory markers such as AST, ALT and GGT lack sufficient sensitivity and specificity.
  
  
  OBJECTIVE
  To study the clinical, biochemical and histological differences between non-alcoholic steatohepatitis (NASH) and alcoholic steatohepatitis (ASH).
  
  
  METHODS
  Sixty histologically confirmed cases of non-alcoholic steatohepatitis and 38 cases of alcoholic steatohepatitis were included in the study. A modified form of scoring system proposed by Yip and Burt was used to grade histological features of NASH and ASH.
  
  
  RESULTS
  Mean age was 42.85 +/- 12.36 years in ASH group and 35.07 +/- 8.06 years for NASH group. Male: Female ratio was 37:1 in ASH and 4:1 in NASH. The mean ALT (P = 0.012), SAP (P = 0.003), serum bilirubin (P = 0.001), AST/ALT ratio (P = 0.03), steatosis (P < 0.001), ballooning degeneration of hepatocytes (P < 0.001), portal inflammation (P < 0.001), Mallory hyaline (P = 0.001), ductular proliferation and fibrosis (P < 0.001) showed a significant difference between ASH and NASH cases.
  
  
  CONCLUSIONS
  Older age, male sex, larger derangement of serum biochemistry, high serum bilirubin, AST/ALT > 1, more ballooning degeneration, portal inflammation, Mallory's hyaline, hepatocytic and ductular cholestasis, ductular proliferation and higher stage of fibrosis favors a diagnosis of ASH. Younger age, high ALT, AST/ALT < 1, higher grade of steatosis and absence of extensive neutrophilic portal inflammation favors a diagnosis of NASH.
authors.affiliation: Department of Pathology, G B Pant Hospital, Delhi, India.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Singh
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
authors.forename: Ranjana
authors.initials: R
authors.lastname: Gondal
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People; D002648:Child; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007194:India; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult