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understanding-nash
 
What Is NASH? Dom Test
Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD)1
  • NAFLD is a condition in which fat accumulates in the liver in individuals without a history of alcohol abuse.1
  • NASH is a severe type of NAFLD characterized by cellular injury and inflammation that may lead to fibrosis (scarring) or even cirrhosis of the liver2
    –Hallmark characteristics of NASH include3,4:
    • ≥5% hepatic steatosis
    • Hepatocellular ballooning
    • Lobular inflammation of the liver with or without fibrosis
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NASH affects millions of Americans and is on the rise5
  • NASH is likely to become the most common cause of advanced liver disease in the coming decades6
  • A recent survey of hepatologists and gastroenterologists revealed that <25% of respondents routinely perform liver biopsy in patients with presumed NAFLD, suggesting that NASH is underdiagnosed7
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WATCH: Nonalcoholic steatohepatitis: Fibrosis in patients with NASH Learn more about the mechanism of disease of NAFLD and NASH.
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NASH Is a Chronic Liver Disease That Can Impact Mortality and Quality of Life9-11
Liver fibrosis and progression to cirrhosis are key predictors of NASH mortality9
  • Risk of all-cause mortality is highest in patients with cirrhosis of the liver9Mobile_Home_graphic_LiverRelated
  • According to a meta-analysis analyzing fibrosis stage-specific mortality ratios of 5 NAFLD cohort studies, risk of liver-related mortality increases substantially in patients with liver fibrosis, with significantly higher rates observed in patients with stage 2 fibrosis or higher9
  • NASH is the fastest-growing cause of hepatocellular carcinoma (HCC) in the US,12 with a 940% increase of NASH-related HCC as an indication for liver transplant between 2004 and 201613
    –However, cardiovascular disease is the leading cause of death in patients with NAFLD4
  • Complications of NASH may also negatively impact health-related quality of life,* particularly for patients with cirrhosis10,11
*Assessed using the Short Form 36 questionnaire and the Chronic Liver Disease Questionnaire, 2 validated health-related quality of life questionnaires used frequently in the NASH literature.10
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References:
  1. Takahashi Y, Fukusato T. Histopathology of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 2014;20(42):15539-15548.
  2. Schiff ER. Fibroscan (transient elastography) for the measurement of liver fibrosis. Adv Hepatol. 2017;13(6):378-380.
  3. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012 Jun;142(7):1592-1609.
  4. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.
  5. Spengler EK. Recommendations for diagnosis, referral for liver biopsy, and treatment of NAFLD and NASH. Mayo Clin Proc. 2015;90(9):1233-1246.
  6. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274-285.
  7. Rinella ME, Lominadze Z, Loomba R, et al. Practice patterns in NAFLD and NASH: real life differs from published guidelines. Ther Adv Gastroenterol. 2016;9(10):4-12.
  8. US Census Bureau. QuickFacts. 2017. https://www.census.gov/quickfacts/fact/table/US/PST045217. Accessed October 12, 2018.
  9. Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65(5):1557-1565.
  10. Kennedy-Martin T, Bae JP, Paczkowski R, Freeman E. Health-related quality of life burden of nonalcoholic steatohepatitis: a robust pragmatic literature review. J Patient Rep Outcomes. 2018;2(28):1-14.
  11. Loria A, Escheik C, Gerber NL, Younossi ZM. Quality of life in cirrhosis. Curr Gastroenterol Rep. 2013;15(1):301. doi: 10.1007/s11894-012-0301-5.
  12. Younossi ZM. The epidemiology of nonalcoholic steatohepatitis. Clin Liver Disease. 2018;11:92-94.
  13. Noureddin M, Vipani A, Bresee V, et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018 Jun 8. doi:10.1038/s41395-018-0088-6.