This chapter will discuss state-of-the-art of various therapies for nonalcoholic fatty liver disease (NAFLD). As only patients with nonalcoholic steatohepatitis (NASH) are generally at risk for progressing to end-stage liver disease and hepatocellular carcinoma, liver-directed therapies to improve or reverse NASH are directed at this population. The most tested options with some efficacy are weight loss, vitamin E, and pioglitazone. In the morbidly obese patients with NASH, bariatric surgery is effective at improving or resolving the liver injury, but its safety is unknown in NASH patients with cirrhosis. Liver transplantation offers excellent patient and graft survival for NASH patients with cirrhosis and liver failure or early stage hepatocellular carcinoma. Existing literature does not currently support the use of many previously tested agents for NAFLD and NASH such as metformin, long-chain polyunsaturated fatty acids, or ursodeoxycholic acid. A number of emerging therapeutics agents in different stages of testing are reviewed as well. Recent data from a large randomized trial of obeticholic acid in patients with NASH is encouraging but requires validation and long-term safety data. Finally, addressing the metabolic and cardiac comorbidities is an important element in managing all patients with NAFLD. In this setting, statins can be safely used when indicated to treat dyslipidemia.
|Original language||English (US)|
|Title of host publication||Alcoholic and Non-Alcoholic Fatty Liver Disease|
|Subtitle of host publication||Bench to Bedside|
|Publisher||Springer International Publishing|
|Number of pages||25|
|State||Published - Jan 1 2015|
ASJC Scopus subject areas