The Silent Liver Disease – What You Need to Know About NASH - Wake Research

The Silent Liver Disease – What You Need to Know About NASH

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Liver disease is a broad term that encompasses a range of conditions, including viral hepatitis, cirrhosis, and cancer. However, one form of liver disease on the rise is nonalcoholic steatohepatitis (NASH). NASH is a silent disease that often goes undiagnosed until it progresses to advanced stages.

What Is NASH?

NASH is characterized by the presence of fat in the liver and inflammation. It is a progressive disease that can worsen over time, leading to cirrhosis. Cirrhosis is a severe form of scarring that can then cause complications such as liver cancer and liver failure.

NASH results by a combination of factors such as obesity, high cholesterol, and type 2 diabetes. NASH is estimated to affect around 5% of people in the United States. (1)

Who Can Get NASH?

NASH can affect anyone, but it is more common in people with certain risk factors, such as:

  • Obesity: Being overweight or obese increases your risk of developing NASH.
  • Metabolic disorders: People with high cholesterol, type 2 diabetes, and other metabolic disorders are at a higher risk of developing NASH
  • Gastric bypass surgery: People who have had gastric bypass surgery are at a higher risk of developing NASH.

Signs and Symptoms of NASH

The signs and symptoms of NASH often go unnoticed in its early stages, as it is considered a “silent disease.” However, as the condition progresses, some people may experience the following symptoms:

  • Fatigue
  • Weakness
  • Weight loss
  • Abdominal pain
  • Nausea
  • Yellowing of the skin and eyes (jaundice)
  • Itching
  • Bruising easily
  • Spider-like blood vessels on the skin
  • Swelling in the legs or abdomen
  • Confusion, drowsiness, or slurred speech

How Is NASH diagnosed?

NASH is typically diagnosed through a combination of tests and exams. Below are the most common methods used to diagnose NASH.

Physical Examination

Your doctor will perform a physical exam to check for signs of liver damage, such as an enlarged liver or a tender liver.

Blood Tests

Your doctor will order blood tests to check for elevated liver enzymes, which can indicate liver inflammation. They may also check for other markers of liver disease, such as high bilirubin or low albumin.

Imaging Tests

Imaging tests such as ultrasound, CT scan, or MRI may be used to check for signs of fatty liver or liver fibrosis.

Liver Biopsy

A liver biopsy is the most definitive way to diagnose NASH. During the procedure, a small sample of liver tissue is removed and examined under a microscope to look for signs of inflammation and liver cell damage.

Treatment options for NASH

You have several treatment options for NASH, including lifestyle changes, medications, and surgery.

Lifestyle changes

The initial treatment for NASH typically includes lifestyle changes, such as losing weight through a healthy diet and regular exercise and managing any underlying conditions, such as diabetes or high cholesterol. (2)


The FDA currently approves no medications specifically for NASH; however, several medications are effective in treating NASH. These include: (4)

  • Vitamin E: This antioxidant has been shown to reduce liver inflammation and improve liver function in people with NASH.
  • Pioglitazone: This medication is used to treat type 2 diabetes and has been shown to improve insulin sensitivity and reduce liver fat in people with NASH.
  • Metformin: This medication is also used to treat type 2 diabetes and has been shown to improve insulin sensitivity and reduce liver fat in people with NASH.
  • Obeticholic acid (OCA): This medication is used to treat primary biliary cholangitis and has been shown to improve liver function and reduce fibrosis in people with NASH.

Bariatric Surgery

In severe cases of NASH and obesity, bariatric surgery may be considered a treatment option. Gastric bypass surgery and sleeve gastrectomy have resulted in significant weight loss and improved NASH.

Liver Transplant

In advanced cases of NASH, liver transplantation may be necessary if the liver has been severely damaged.

These treatments may not be suitable for everyone, and the best treatment will depend on the individual case. It is essential to discuss with a healthcare professional to determine the best course of treatment.

Importance of NASH Clinical Research

Keeping up to date with the latest clinical research on NASH is important for several reasons. (3)

First, NASH is a complex disease that is not well understood, and ongoing research is helping to shed light on its causes and potential treatments. By staying informed about the latest NASH research, healthcare providers can provide their patients with the most up-to-date and accurate information about the disease and its management.

Second, new treatments and therapies for NASH are constantly being developed and tested, and keeping up to date with the latest research can help healthcare providers stay aware of these new options and make informed decisions about how to best treat their patients.

Finally, NASH is a progressive disease, which means that it can get worse over time. Early detection and management of the disease can help prevent or delay the progression of liver damage. With the latest medical research on NASH, healthcare providers can help provide patients with the best care possible for this growing health concern.


NASH is a growing health concern in the United States and worldwide. It is a silent liver disease that can cause serious complications if left untreated. Anyone with risk factors for NASH should be aware of the disease and seek medical attention if they have symptoms.


  1. NASH Definition and Prevalence. American Liver Foundation.’s%20estimated%20that%20about%2025,NAFLD%20have%20simply%20fatty%20liver.
  2. Non-Alcoholic Fatty Liver Disease (NAFLD) and Bariatric/Metabolic Surgery as Its Treatment Option: A Review, National Library of Medicine. National Center for Biotechnology Information.
  3. NASH Treatment. American Liver Foundation.,important%20in%20managing%20your%20disease
  4. FDA Updates for the Week. Managed Healthcare Executive.
  5. M3 Wake Research,