Comparison of clinical, biochemical and histological features of alcoholic steatohepatitis and non-alcoholic steatohepatitis in Asian Indian patients.
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.
Singh
Deepak Kumar
DK
Department of Pathology, G B Pant Hospital, Delhi, India.
Rastogi
Archana
A
Sakhuja
Puja
P
Gondal
Ranjana
R
Sarin
Shiv Kumar
SK
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