State of the art: treatment of nonalcoholic steatohepatitis.
OBJECTIVE
Nonalcoholic fatty liver disease is the most common cause of chronic liver disease in Western countries, and consists of a spectrum of histopathological changes that range in severity from simple steatosis to steatohepatitis to cirrhosis. The use of pharmacological agents as adjunctive therapy to lifestyle modification is crucial, because weight loss is often difficult to achieve and maintain. The purpose of this review is to analyze the most recent literature pertaining to current therapies for nonalcoholic steatohepatitis (NASH), as there are currently no Food and Drug Administration-approved medications.


RESULTS
Recent studies suggest that vitamin E may improve liver histology in NASH without affecting insulin resistance; however, long-term risks remain to be studied. Pioglitazone is beneficial in improving liver histology and insulin resistance, but is associated with weight gain. Emerging data suggest that pentoxifylline may also be beneficial in improving serum aminotransferase and liver histology in patients with biopsy-proven NASH.


CONCLUSIONS
Ongoing research evaluating potential pharmacological agents for NASH is critical, because these patients are at an increased risk for cirrhosis and hepatocellular carcinoma. The current therapies being used for the treatment of NASH include the use of vitamin E and pioglitazone, in addition to dietary counseling and regular exercise.
aDivision of Gastroenterology, Department of Medicine bDivision of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California, USA.
Michelle
M
Pearlman
Rohit
R
Loomba
D000975:Antioxidants / Q000627:therapeutic use; D015444:Exercise; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D065626:Non-alcoholic Fatty Liver Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D010431:Pentoxifylline / Q000627:therapeutic use; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D015431:Weight Loss
D000975:Antioxidants; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D014810:Vitamin E; D010431:Pentoxifylline; D000077205:Pioglitazone