The Big (& Small) Picture of NASH: Building Your Understanding to Combat a Growing Problem

Nonalcoholic steatohepatitis (NASH), part of the nonalcoholic fatty liver disease (NAFLD) spectrum, is characterized by steatosis, lobular inflammation, hepatocyte ballooning, and varying degrees of fibrosis.1 Both obesity and diabetes play large roles in development and progression of NAFLD and NASH, and the growing prevalence of NAFLD and NASH parallel the rise in obesity and diabetes.2 In addition to obesity and diabetes, multiple comorbidities occur with NASH; the 2 comorbidities that are strongly tied to mortality are cardiovascular disease and malignancy.3,4 Liver biopsy, often impractical or unfeasible, is the gold standard for diagnosis.5 Recently, noninvasive modalities, particularly imaging, have been used as substitutes to identify patients at risk for disease progression; there are, however, deficits in knowledge and access to some noninvasive modalities. Though there is no US Food and Drug Administration (FDA)-approved treatment for NASH, fibrosis, along with other histopathologic markers of NASH, can be improved through lifestyle modification or off-label use of therapies.5 Recent clinical trial data have been encouraging, but management of patients with NASH still proves difficult, necessitating education about diagnosis and management.