title: Systematic review with meta-analysis: non-alcoholic steatohepatitis - a case for personalised treatment based on pathogenic targets.
abstract: BACKGROUND
  Non-alcoholic fatty liver disease (NAFLD) is an umbrella term, which encompasses simple steatosis and non-alcoholic steatohepatitis (NASH). The entire spectrum of NAFLD has been associated with metabolic syndrome. NASH is associated with increased mortality compared with that of the general population. Many therapeutic options for NASH have been studied. However, there is very little evidence supporting the efficacy of most regimens for the treatment of NASH.
  
  
  OBJECTIVE
  To provide a review focusing on the current therapeutic options available for patients with NASH as well as to briefly introduce possible future interventions.
  
  
  METHODS
  A MEDLINE, Pubmed and Cochrane Review database search using a combination of keywords, which included non-alcoholic fatty liver disease, non-alcoholic hepatic steatosis, NAFLD, NASH, treatment, therapeutics, vitamin E, orlistat and bariatric surgery. An overall summary of the articles was developed for each section of discussion in this review.
  
  
  RESULTS
  NASH associated with metabolic syndrome can progress advanced fibrosis and cirrhosis. Weight loss and lifestyle modification have been shown to improve NASH. Other medications used for weight loss and metabolic syndrome have been evaluated, such as orlistat, metformin and thiazolidinediones. Alternative regimens using ursodeoxycholic acid, statins and probiotics as well as bariatric surgery have been evaluated, but have not been recommended as first-line treatment for NASH. Vitamin E for NASH patients without diabetes seems to be promising. The lack of effective treatment for NASH suggests the heterogeneity of patients presenting with the NASH phenotype. The best treatment strategy for these patients may be to identify their pathogenic target and develop personalised treatment protocols.
  
  
  CONCLUSIONS
  Currently, there are few options available for the management of NASH. Future targeted treatment strategies based on the pathogenic pathways may be needed to develop effective treatment for patients with NASH.
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Younossi
authors.forename: M J
authors.initials: MJ
authors.lastname: Reyes
authors.forename: A
authors.initials: A
authors.lastname: Mishra
authors.forename: R
authors.initials: R
authors.lastname: Mehta
authors.forename: L
authors.initials: L
authors.lastname: Henry
mesh_terms: D050110:Bariatric Surgery; D005234:Fatty Liver / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007783:Lactones / Q000627:therapeutic use; D024821:Metabolic Syndrome / Q000628:therapy; D008687:Metformin / Q000627:therapeutic use; D065626:Non-alcoholic Fatty Liver Disease; D000077403:Orlistat; D057285:Precision Medicine; D045162:Thiazolidinediones / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D015431:Weight Loss
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007783:Lactones; D045162:Thiazolidinediones; D014810:Vitamin E; D014580:Ursodeoxycholic Acid; D008687:Metformin; D000077403:Orlistat