Cirrhosis is a degeneration of the liver, commonly associated with alcohol abuse or viral hepatitis. However, excessive alcohol consumption – however harmful – is not the only cause of cirrhosis.
NASH – or non-alcoholic steatohepatitis, is a liver disease characterized by the accumulation of fat, whose most fearful complication is cirrhosis. Not depending on alcohol intake, therefore, NASH can also affect abstainers.
We deepen the topic with Professor Ana Lleo De Nalda, hepatologist in Humanitas and at the Humanitas Medical Care Premuda clinic in Milan.
What is cirrhosis?
When we talk about cirrhosis we are referring to a degeneration of the liver linked to the excessive accumulation of fibrous tissue, which causes alterations in its structure and functions.
These factors can lead to increased pressure in the main vein of the liver (the portal vein) and also to the organ’s inability to synthesize essential proteins for the body such as albumin.
This will then lead to bleeding from the upper digestive tract, the appearance of ascites – the fluid that accumulates in the abdominal area – and swelling in the legs. Furthermore, the liver is unable to metabolize the substances absorbed by the intestine and eliminate toxins:
Among the causes of cirrhosis, in addition to alcohol abuse and non-alcoholic steatohepatitis, in adults we indicate:
- hepatitis B;
- hepatitis C;
- autoimmune liver disease caused by an overactive immune system;
accumulation of iron or copper.
Non-alcoholic steatohepatitis: what are the causes
Non-alcoholic steatohepatitis (NASH) is a disease linked to the accumulation of fat in the liver. This is a more serious condition than simple steatosis also known as “fatty liver”, because non-alcoholic steatohepatitis leads to inflammatory processes, scarring and tissue death, which can ultimately alter the function of the organ.
Non-alcoholic steatohepatitis is more likely to be found in obese, overweight people or people who generally perform little physical activity, and is often associated with the presence of diabetes or metabolic syndrome.
The main causes of nonalcoholic steatohepatitis are:
- improper diet, too high in fat;
- being overweight or obese;
- dyslipidemia, which is the presence of high levels of triglycerides and cholesterol in the blood;
- type 2 diabetes.
Non-alcoholic steatohepatitis: symptoms
Symptoms of nonalcoholic steatohepatitis occur only when the stage of cirrhosis is already advanced, are common to all causes of cirrhosis and include:
- swelling in the legs;
- bleeding from the gastrointestinal tract;
Furthermore, cirrhosis can give rise to liver tumors.
Steatohepatitis: how is it treated?
Before talking about therapy, it is important to talk about prevention: steatohepatitis is fought in advance, avoiding a sedentary lifestyle, carrying out regular physical activity and following a balanced diet, rich in vegetable proteins, whole grains, fish and white meats, but low in red meat and as much as possible free of sweets and alcohol. In this sense, the Mediterranean diet is particularly suitable for reducing weight and therefore reducing the amount of steatosis.
- Once steatosis has taken hold, the degenerative process that will lead to non-alcoholic steatosis into hepatic fibrosis cannot be stopped with commercially available drugs.
- The lifestyle, however, must necessarily be changed, improving nutrition, blocking a sedentary lifestyle and banning alcohol.
To date, there are no registered drugs for the treatment of non-alcoholic steatohepatitis; however, there are numerous clinical trials (also active in Humanitas) with molecules with different mechanisms of action, some of which appear to be promising.