Diagnosis, follow-up and treatment of metabolic liver diseases (steatosis, steatohepatitis)

Non-alcoholic fatty liver disease (NAFLD, hepatic steatosisfatty liver) is the most common liver disease in the western world. In fact, it represents the hepatic manifestation of metabolic disorders (i.e. the metabolic syndrome) caused by overeating and poor physical activity, namely obesity, diabetes mellitus and dyslipidemia. In most cases, non-alcoholic steatotic liver disease is a benign entity with no progression. On some occasions, however, it assumes connotations of greater aggressiveness.

In this case, it is more correct to speak of  non-alcoholic steatohepatitis (NASH) which has the potential to progress into liver cirrhosis and hepatocellular carcinoma. Although the factors that determine the transition from hepatic steatosis to steatohepatitis are not fully known, it is believed that the main determinants are the severity of the underlying metabolic disorders and the genetic predisposition of the individual. From the point of view of genetic predisposition, in recent years there has been a growth in the evidence linking certain genetic polymorphisms (i.e. variants of genes present with a certain frequency in the general population) with the development of steatosis, steatohepatitis and disease progression.

The patient suffering from hepatic steatosis therefore deserves a first comprehensive evaluation, aimed at identifying the basic metabolic disorders and any other contributing factors, as well as identifying the stage of disease and the risk of progression. On the basis of this evaluation, it will be possible to proceed with personalised indications relating to the therapeutic approach and controls over time. In fact, although diet and physical activity still represent the mainstay of the treatment of steatotic liver disease, many drugs under study have shown promising results and it is hoped that these will soon translate into concrete therapeutic opportunities.

The Clinical Medicine and Hepatology Unit of the University Campus Bio-Medico Hospital has always paid particular attention to patients suffering from non-alcoholic steatotic liver disease It has cutting-edge diagnostic tools (study of genetic polymorphisms, ultrasound with gradation of steatosis according to validated systems, evaluation of liver fibrosis using elastometry, etc.), at the end of which the patient is directed to more treatment and controls indicated for the specific case.