title: Non-alcoholic fatty liver disease: what has changed in the treatment since the beginning?
abstract: Non-alcoholic fatty liver disease (NAFLD) is an umbrella term to describe the entire spectrum of this common liver disease. In patients with NAFLD, especially those with non-alcoholic steatohepatitis (NASH), most often have one or more components of the metabolic syndrome, but this is not universal. Although most patients with NAFLD share many clinical features, only a subset of patients develops significant liver inflammation and progressive fibrosis. On the other hand, not all patients with NASH exhibit insulin resistance. NASH can be seen in patients who are lean and have no identifiable risk factors. Many clinical studies have tried numerous drugs and alternative medicine, however, investigators have failed to identify a safe and effective therapy for patients with NASH. As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.
authors.affiliation: Bülent Baran, Filiz Akyüz, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Capa, 34093 Istanbul, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Baran
authors.affiliation: Bülent Baran, Filiz Akyüz, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Capa, 34093 Istanbul, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyüz
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D005762:Gastroenterology / Q000639:trends*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D050356:Lipid Metabolism / Q000187:drug effects; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018384:Oxidative Stress / Q000187:drug effects; D011237:Predictive Value of Tests; D012084:Renin-Angiotensin System / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000975:Antioxidants; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents
keywords: Fibrosis; Inflammation; Life-style changes; Non-alcoholic steatohepatitis; Pathogenesis; Pharmacologic treatment