Fatty Liver Disease Program
NAFLD refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. Simple fatty liver is the most common form and is generally not considered to do long-term damage to the liver.
What is NASH?
A small group of people with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH). In NASH, fat accumulation is associated with liver cell inflammation and different degrees of scarring. NASH is a potentially serious condition that may lead to severe liver scarring and cirrhosis. This is the reason why NAFLD is becoming the most common cause of cirrhosis in the country.
What is Cirrhosis?
Cirrhosis occurs when the liver sustains substantial damage, and the liver cells are gradually replaced by scar tissue (see figure), which results in the inability of the liver to work properly. Some patients who develop cirrhosis may eventually require a liver transplant (surgery to remove the damaged liver and replace it with a “new” liver.
How common is NAFLD / NASH?
NAFLD is a very common disorder. NAFLD is estimated to be present in one third of the general population in the United States. NASH occurs in 3% of the population but may be found in more than 25% of obese persons.
Obesity is thought to be the most common cause of fatty infiltration of the liver. In the past ten years the rate of obesity in our country has doubled in adults and tripled in children and teenagers, which may explain why NAFLD and NASH are becoming more common.
The prevalence of overweight persons (body mass index [BMI] ≥25 kg/m2) in the United States has risen to more than 65%, and obesity (BMI ≥30 kg/m2) is now present in more than 30% of the adult U.S. population.
What causes NASH?
NAFLD is part of the metabolic syndrome characterized by
- Diabetes, or pre-diabetes (insulin resistance)
- Being overweight or obese
- Sleep apnea
- Polcystic Ovarian Syndrome
- Coronary artery disease
- Elevated blood lipids such as cholesterol and triglycerides
- High blood pressure.
Not all patients have all the manifestations of the metabolic syndrome.
What are signs and symptoms of NAFLD / NASH?
The majority of individuals with NAFLD have no symptoms and a normal examination. Some people may have vague upper abdominal discomfort and fatigue. Most of the time, NAFLD causes no symptoms until the liver is significantly damaged.
How is NAFLD / NASH diagnosed?
The diagnosis of NAFLD is usually first suspected in an overweight or obese person who is found to have mild elevations in their liver tests during a routine blood testing. However NAFLD can be present with normal liver blood tests. The diagnosis of NAFLD can also be made by imaging studies, most commonly a liver ultrasound, showing accumulation of fat in the liver. To make things more complicated, NAFLD can also occur in people who are not obese.
Either abnormal liver tests or abnormal imaging studies should prompt further testing.
Currently, the only reliable way of telling whether a person has NASH or simple fatty liver is by a liver biopsy. There are several promising blood tests and imaging studies, but none can replace a liver biopsy at this point. In this procedure, a small needle is inserted through the skin after local anesthesia is given to obtain a small piece of the liver for microscopic evaluation. NASH is diagnosed when examination of this piece of liver under the microscope shows fatty infiltration of the liver in addition to inflammation and different degrees of scarring. If only fat is present, then the diagnosis of simple fatty liver is made. The liver biopsy provides essential information regarding the degree of scarring within the liver, which would not be apparent on a blood test, ultrasound, or an x-ray alone. Liver biopsy rarely can be associated with serious risks including bleeding and patients should discuss the risks and benefits of the procedure with their physician.
What are the risks of having NAFLD / NASH?
Most people with NAFLD, especially those with simple fatty liver with no inflammation, have little or no problems from the condition, although some studies have shown that even simple fatty liver can progress to cirrhosis in a small proportion. In contrast, about a quarter of people with NASH may have scarring of the liver that gets worse with time. In some patients the scarring can stabilize and in persons who have lost significant amounts of weight there are cases where scarring has been shown to reverse. In others, the progression continues with scar tissue accumulating in the liver, leading to cirrhosis. NASH is an increasingly common reason for liver transplantation in the United States.
How is NAFLD / NASH treated?
This is an area of intense research. In fact we have many (over 12) clinical studies at our site enrolling NASH patinets for several promising treatments.The most important aspect of treatment is the management of metabolic syndrome. Weight reduction, even if small, can improve the effect on liver. In addition, change in the types of food eaten and physical exercise have independently beneficial effects on Fatty Liver disease.
Factors currently being evaluated by physicians and scientists to decrease the amount of fat in the liver include:
- Weight reduction (diet + exercise, medications, surgery)
- Lipid lowering medications
- Insulin sensitizers (medications)
- Anti-fibrotic agents
- Decrease the amount of liver inflammation by administering anti-oxidant medications, anti-apoptotic medications and anti-cytokine medications.
How does Fatty Liver Disease Clinic help?
Fatty Liver Disease clinic at Ohio Gastroenterology and Liver Institute is the first comprehensive program for managing all aspects of Fatty Liver Disease in adults in the Tri-state area. We have board certified liver specialists overseeing the management and a dietician specifically designing diets for our patients. We perform liver biopsies at our surgical centers and our liver specialists interpret them with our own pathologist. We have a large research division performing cutting edge research where our patients can enroll for new treatments. We currently have about 12 clinical trials for NASH.
Our Clinic works closely with your doctor and coordinates all referrals as needed. We accept most insurances. For dietician services portion, there are affordable plans if insurance does not cover.
On site fully staffed Liver Research Unit with ongoing clinical trials with cutting edge medicines.
- Endoscopic treatment for esophageal varices, gastric varices and other liver related problems
- Ultrasonography including dopplers of liver vessels provided on site with immediate feedback and appropriate action from the doctors
- Shearwave Elastography for non invasively estimating fibrosis in the liver
- Liver Biopsy done at our outpatient centers by our liver specialists and interpreted by our pathologist after collaborative discussion
- Endoscopic Ultrasound and ERCP for management of hepatobiliary diseases.
As a part of our Liver Clinic, we offer liver transplantation expertise in collaboration with University of Cincinnati and University of Kentucky. We have two board certified Transplant Hepatologists and Dr. Ravinuthala is on faculty at University of Kentucky and University of Cincinnati. We routinely evaluate, collaborate and arrange for liver transplantation in appropriate situations.