Current treatments in nonalcoholic steatohepatitis

Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the United States secondary to the growing obesity epidemic. Although most patients with NAFLD do not develop progressive liver disease, the subset of NAFLD patients with nonalcoholic steatohepatitis (NASH) are at risk for progression to cirrhosis and hepatocellular carcinoma, which necessitates appropriate follow-up and management. Unfortunately, proven treatment modalities for NASH that result in complete histopathologic regression of steatosis, inflammation, and fibrosis do not exist. Many therapeutic approaches to NAFLD management have been attempted, with varying degrees of success. However, most of these studies have been limited to small, single-center, uncontrolled trials. Based on our evolving understanding of the disease's pathogenesis, it seems logical that a multidisciplinary approach addressing the underlying metabolic syndrome and the resultant intrinsic liver injury is necessary. Diet, exercise, surgical weight loss, diabetic medications, and hepatoprotective agents all have been studied and may serve as potential weapons in our armamentarium against this disease. Although most of these approaches have been studied as single-modality therapy, we believe that combination, multimodality therapy is required to treat this disease effectively.