Treatment of Nonalcoholic Steatohepatitis

It is important to stress that there are currently no specific therapies for nonalcoholic steatohepatitis. The most important recommendations given to persons with this disease are to

• reduce their weight (if obese or overweight)
  
  
• follow a balanced and healthy diet
  
  
• increase physical activity
  
  
• avoid alcohol
  
  
• avoid unnecessary medications

These are standard recommendations, but they can make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.

A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with nonalcoholic steatohepatitis and whether this improvement lasts over a period of time.

People with nonalcoholic steatohepatitis often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having nonalcoholic steatohepatitis or elevated liver enzymes should not lead people to avoid treating these other conditions.

Experimental approaches under evaluation in patients with nonalcoholic steatohepatitis include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with nonalcoholic steatohepatitis. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.

Another experimental approach to treating nonalcoholic steatohepatitis is the use of newer antidiabetic medications--even in persons without diabetes. Most patients with nonalcoholic steatohepatitis have insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glucose and fatty acids in the blood than it is for people who do not have nonalcoholic steatohepatitis. The newer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with nonalcoholic steatohepatitis. Studies of these medications--including metformin, rosiglitazone, and pioglitazone--are being sponsored by the National Institutes of Health and should answer the question of whether these medications are beneficial in nonalcoholic steatohepatitis.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/nash/index.htm