Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Hepatic steatosis, a hallmark of non-alcoholic fatty liver diseases (NAFLD), is the hepatic manifestation of the metabolic syndrome and can vary from simple steatosis to cirrhosis and hepatocellular carcinoma. The pathogenesis of NAFLD is linked to a multiple-hit process. Although epidemiological data varies widely, it can be admitted that a realistic prevalence is around 30% of the general population. Its high prevalence in the general population and its many causes and complex mechanisms make it a pathology which must be treated and requires careful diagnosis also in terms of underlying causes, which may strongly vary among subjects. Non-invasive diagnostic methods should be able to reflect the presence and severity of liver fatty changes and the presence and severity of hepatic inflammation and fibrosis, since these are related to the risk of progression and clinical complications. The recent awareness of the commonness of NAFLD has prompted intensive research which unraveled many different mechanisms causing hepatic steatosis, from diet to intestinal diseases and liver receptors. Epigenetic factors must be added to this list. The variety of causes and mechanisms open many different potential therapeutic approaches. Performing randomized long-term clinical studies including liver biopsies appears as prerequisite to determine which treatment is the most valuable, however not ignoring that the therapeutic choice may require individualization among subjects as a function of the origins of NAFLD.

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