Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease by Williams Roger; Taylor-Robinson Simon D.; & Simon D. Taylor?Robinson

Author:Williams, Roger; Taylor-Robinson, Simon D.; & Simon D. Taylor?Robinson
Language: eng
Format: epub
Publisher: John Wiley & Sons, Incorporated
Published: 2016-05-16T00:00:00+00:00

NAFL

When steatosis is present but lobular inflammation or ballooning are absent, the minimal requirements for steatohepatitis are not met, and the diagnosis should be NAFL (non-alcoholic fatty liver, i.e., non-NASH NAFLD) [31]. The terms probable or possible NASH should be abandoned as they create confusion both for the practicing clinician and for clinical trials. Therefore, NAFL encompasses either (i) steatosis alone or (ii) steatosis with lobular or portal inflammation, without ballooning, or (iii) steatosis with ballooning but without inflammation [31]. Recent studies suggest a distinction between steatosis with and without inflammation: steatosis with inflammation could progress to steatohepatitis (sometimes with bridging fibrosis) while progression seems exceptional for steatosis alone [37, 38]. Earlier studies have suggested that inflammation is highly associated with fibrosis progression [39]. The diagnosis of NAFLD should therefore be divided into (i) steatohepatitis (NASH) and (ii) NAFL (non-NASH NAFLD). The latter can be further subdivided into steatosis alone or steatosis with inflammation. Although this dichotomized diagnostic approach (NAFL vs. NASH) is clinically useful, it is an oversimplification that does not reflect the histological complexity of the disease such as cases of steatofibrosis as mentioned previously. Indeed, and as for any other chronic liver diseases, NAFLD might display a wide continuous spectrum of histological lesions so that splitting the disease into NAFL and NASH is artificial. Therefore, semiquantitative scoring system might better mirror the complexity of the histological pattern.

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