How Can We Help?
Steatohepatitis
- NAFLD – non-alcoholic fatty liver disease – fatty liver
- NASH – fatty liver with inflammation and/or fibrosis
- DIS – drug induced steatosis
- DISH – drug induced steatohepatitis
- CASH – chemotherapy associated steatohepatitis
- MAFLD – metabolic dysfunction associated fatty liver disease
- DIFLD – drug induced fatty liver disease
Each review of the subject seems to find a new acronym, but the main issue is that metabolic dysregulation in obese individuals leads to varying degrees of fatty infiltration of the liver, presenting either without symptoms (often discovered incidentally on ultrasound done for another reason) or with malaise, and occasionally with right upper quadrant discomfort.
Management is with weight loss.
There are a couple of important caveats before labelling somebody as having NAFLD – consider medication as a cause, and remember that it can also occur in lean patients1
Medications associated with steatosis include amiodarone, aspirin, paracetamol, ibuprofen, valproate, losartan and omeprazole, whereas corticosteroids and NRTIs may exacerbate a pre-existing NAFLD. Chemotherapy agents (methotrexate, irinotecan, tamoxifen) probably also act by exacerbating existing disease.2
Verdelho Machado M, Cortez-Pinto H. Fatty liver in lean patients: is it a different disease? Ann Gastroenterol. 2012;25(1):1-2. PMID: 24713794; PMCID: PMC3959355. ↩
Kolaric TO, Nincevic V, Kuna L, Duspara K, Bojanic K, Vukadin S, Raguz-Lucic N, Wu GY, Smolic M. Drug-induced Fatty Liver Disease: Pathogenesis and Treatment. J Clin Transl Hepatol. 2021 Oct 28;9(5):731-737. doi: 10.14218/JCTH.2020.00091. Epub 2021 Sep 14. PMID: 34722188; PMCID: PMC8516847. ↩