Non-alcoholic steatohepatitis (NASH): a disease of emerging identity and importance.

ALTHOUGH its histological features had long been recognized (1). the term non-alcoholic steatohepatitis (NASH) was first used by Ludwig et al. as recently as 1980 (2). Although it is commonly encountered in hepatology outpatient (office) practice (3). surprisingly little attention has been paid to NASH. It will be the purpose of this review to examine the clinical and pathological features of NASH. to discuss its possible pathogenesis. and in the light of these to suggest possible management strategies. Ludwig et al. described “the pathological and clinical features of non-alcoholic disease of the liver associated with the pathological features most commonly seen in alcoholic liver disease itself”. This initial description remains appropriate since non-alcoholic. but alcoholic-like. liver disease ranges from simple steatosis through steatohepatitis and fibrosis to cirrhosis with fat. It may also be speculated that some causes of cryptogenic (non-fatty) cirrhosis originally arose through the NASH sequence and subsequently lost the fat (4). We suggest that the above spectrum. of which NASH is the central and most important entity, may be regarded as an acquired metabolic disease of the liver. resulting in the deposition of triglyceride within hepatocytes. in which progression to necro-inflammation. fibrosis and cirrhosis may occur.