NASH (English acronym meaning: non-alcoholic steatohepatitis) is due to the accumulation of fat in the liver linked to poor eating habits and a sedentary lifestyle.
Screening for NASH is therefore indicated in patients at risk: type 2 diabetics and obese.
Between 25 and 30% of the population would be affected
It is developing in a worrying manner in industrialized countries. Between 25 and 30% of the population would be affected. It will soon be the 1re cause of liver transplant.
Symptoms do not usually appear until the stage of cirrhosis. And it is often discovered accidentally.
Leading cause of chronic liver disease worldwide
Metabolic disease, it is managed by different specialists at HCL (endocrinologists, hepatologists, transplanters, bariatric surgeons).“Fat overload can remain benign: this is NAFLD* (nonalcoholic fatty liver disease). This is the 1re cause of chronic liver disease worldwide, with a prevalence of 25.7% and 3% to 10% in children and adolescents » explains Professor Cyrielle CAUSSY, endocrinologist in the Endocrinology-Diabetes-Nutrition service.
“But some patients develop a more serious form with inflammation progressing towards fibrosis, this is NASH. This pathology is then more than a liver disease because it is at the center of the entire metabolic process. The chronically diseased and inflamed NASH liver produces many circulating molecules, with detrimental effects. Thus, the first danger for NASH patients is indeed cardiovascular. she continues.
In the absence of non-invasive diagnostic tests, its prevalence is not precisely known, but we know that 25 to 30% of people hang yourself or type 2 diabetics are affected.
First-line tests can be prescribed by general practitioners: an abdominal ultrasound to look for a fatty liver, a blood test associated with biological scores make it possible to exclude cases of serious form. If NASH is suspected, treatment by a hepatologist who works in conjunction with endocrinologists is recommended.
Change your lifestyle to act on the disease
“The progression of liver fibrosis is accompanied by an increased risk of developing liver cancer, even before the establishment of complete liver cirrhosis and the development of hepatic decompensation.” explains Prof. Massimo LEVRERO, hepatologist in the hepatology and gastroenterology department.
“To date, there is no approved medication, and only weight loss is recommended. Patients with NASH can act on the disease by changing their lifestyle. An effective and lasting modification can have an effect on NASH and even on fibrosis, subject to a lasting weight loss greater than 10% of body mass. However, several new drugs acting on different pathophysiological mechanisms of NASH are under development and are available for patients with a more urgent need in clinical trials carried out in university hospitals, including HCLs..
« Bariatric surgery can help patients with NAFLD/NASH lose weight. It concerns obese people with co-morbidities. It is effective since we note an improvement of 85% in NASH and 35% in fibrosis. specifies Professor Maud Robert, digestive surgeon at HCL. Finally, “Liver transplantation is indicated in cases of terminal progression of cirrhosis”. Explains Jérôme Durmortier, hepatologist in the digestive functional explorations department. “It was the intervention that saved Pierre Ménès. For the moment, liver transplants due to NASH only occur after transplants for alcoholic or viral cirrhosis. But if we follow the American way it will soon be the 1re cause of graft … »
Better detect and combat liver diseases that continue to progress
Nearly 1.5 billion people in the world live with liver disease and more than 2 million die from it each year (including 17,000 in France)1whether due to serious complications linked to cirrhosis, hepatocellular carcinoma (liver cancer) or acute or chronic liver failure (hepatitis B or C). Due in particular to the sharp increase in “fatty liver disease” (NASH), the number of liver cancers could increase by 55%.2globally, by 2040.
By bringing together researchers, clinicians, manufacturers and patient representatives on the same site to work around a single organ, the IHU EVEREST intends to develop new strategies for managing chronic pathologies, with early diagnosis and therapeutic interventions, and new classifications of diseases for the personalization of treatments.
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1 OMS
2 study published in the scientific journal The Lancet
