NASH is the acronym for nonalcoholic steatohepatitis. It’s a type of advanced liver disease that is clinically indistinguishable from alcohol-induced liver damage, but whose causes are totally different. Late stage NASH leads invariably to chronic cirrhosis and ultimately liver failure and death. The most common cause of NASH is long-term obesity, and so the threat has grown in relation to the rising rates of obesity in western society. Therefore NASH is quickly becoming an epidemic, with estimates of 15 to 30 million Americans living with the disease, the vast majority of whom are undiagnosed. They are living with a ticking time bomb inside their bodies.
One of the most challenging things about NASH is that is usually asymptomatic until very late stages. In earlier stages, the only common symptoms are fatigue and mild pain in the upper right abdomen (where the liver is located). As you can imagine, these symptoms can also be easily mistaken for hundreds of other conditions, including just getting older. As such it has been regarded as a silent killer disease. As older generations have aged and lived with obesity over long time periods, the rate of NASH diagnosis’s has dramatically risen, with NASH now surpassing Hepatitis C as the leading cause for liver transplants in adults under age 50. It is likewise on track to overtake Hep C in adults over 50 in the next few years.
There are also very few ways to diagnose the disease itself. The preferred manner until very recently has been through invasive liver biopsy. For obvious reasons, this isn’t a standard diagnostic test. There are a number of blood tests that can be used to make preliminary diagnosis’s but they are also non-standard and not part of any normal checkup process. One of my primary goals in promoting NASH awareness is to make such tests standard for anyone with sufficient risk factors, similar to the way that mammograms and prostate exams have become normal procedures.
There is currently no treatment for NASH. While the liver is the only visceral organ with the ability to regenerate, once serious scarring develops it may become too damaged to repair itself. That means that for suffers of severe NASH the only current treatment option is a transplant. Complicating matters is the fact that generally unhealthy and obese patients are at high risk for transplant failure. Therefore potential transplant patients must usually go through a healthy life change for a period of time to get to a manageable weight and overall health to be considered for transplant. Given the rapid onset of late stage NASH symptoms and liver failure, this is precious time that they may not have.
Several biomedical companies are running large trials that are showing promising results for the treatment of NASH through medicine. Given the enormous size of the potential population that will develop NASH, treatments for the disease are considered the largest untapped matter in medicine. However, even with advanced treatments on the horizon, without more preventative early diagnosis procedures far too many will be faced with dire prospects. The answer for doctors should be simple: if your patient has been obese for more than a few years or has other recognized risk factors then specialized blood tests to detect NAFLD/NASH should be administered.