Where does non-alcoholic hepatitis come from?
The concept of non-alcoholic steatohepatitis was first introduced in 1980. And today it is recognized as very relevant in gastroenterology, since its prevalence is from 14 to 18 percent of the total population. Pathology is more common in women (aged 41-60 years). It is noteworthy that there are no complaints from patients.
Among the many important issues of modern medicine, covered at the All-Russian Educational Internet-session for doctors, the pathogenesis, diagnosis and treatment of non-alcoholic liver steatohepatitis (NASH) were discussed.
In particular, non-alcoholic steatohepatitis was the subject of an extensive report by Svetlana Dmitrievna Podymova, MD Professor, Department of Propaedeutics of Internal Diseases, Moscow State Medical University I.M.Sechenova. At present, NASH is considered an independent disease, which is characterized by an increase in the activity of liver enzymes in blood plasma and morphological changes in liver biopaths, that is, all those changes that are characteristic of patients with alcoholic steatohepatitis. The fundamental difference is that patients with NASH do not abuse alcohol.
Among the signs, only slight discomfort in the abdominal cavity, weakness, malaise are noted.
“The main causes and risk factors,” says Svetlana Dmitrievna Podimova, “are currently recognized:
Obesity is found in 95-100% of patients with fatty liver in general, and in 24-47% of patients with NASH in particular.
Type 2 diabetes mellitus, which occurs in 60% of patients with fatty degeneration and in 15-30% of patients with NASH, respectively.
Hyperlipidemia observed in a high percentage (up to 80%) of patients with NASH. ”
The pathogenesis of the disease is based on the phenomenon of insulin resistance, that is, a metabolic response to endogenous or exogenous insulin, in the development of which a hereditary factor plays a leading role. One way or another, it is insulin resistance that contributes to the violation of the metabolism of fatty acids in the liver cells – hepatocytes. The development of the disease also contributes to oxidative stress, which causes lipid peroxidation, modification, and then death of hepatocytes, inflammation of the liver tissue and the development of fibrosis.
NASH is diagnosed using histological studies and a survey of patients, during which it is necessary to find out that they do not abuse alcohol and do not suffer from diseases (for example, viral) that can provoke steatohepatosis.
Treatment of NASH includes a complex of measures, including both a change in the patient’s lifestyle (diet, increased physical activity) and drug treatment, in which the leading role is played by reducing oxidative stress and restoring hepatocytes themselves. Here hepatoprotectors with essential phospholipids come to the fore.
According to Professor Podymova, the hepatoprotector Essential Forte N is distinguished among other analogues by its convincing evidence base. The drug effectively reduces the degree of oxidative stress, promotes the growth of collagenase activity, the normal, physiological pathway of the most important metabolic processes, which in general contributes to a significant slowdown in the development of fibrosis. “Essential Forte N has the ability to reduce the activity of free radicals and repair damaged hepatocyte membranes, integrating into their damaged areas, promoting cell regeneration,” explains S. D. Podymova.
In addition to hepatoprotectors, such patients are prescribed drugs from the class of biguanides and glitazones, as well as drugs to normalize lipid metabolism. Despite the fact that the latter (in particular statins) adversely affect the liver, doctors consider their appointment to be desirable “under the mandatory protection of hepatoprotectors”, which will ensure their safety.