With effective treatment of Hepatitis C and Hepatitis B, fatty liver is now the most common cause of liver disease in the US. Although it has no clear cause, fatty liver is linked to obesity, insulin resistance, hypertension, heart disease, and elevated cholesterol. Certain ethnic groups, especially Hispanics, have a higher prevalence of fatty liver.
Most commonly, fatty liver does not cause any specific symptoms. However, it may cause mild fatigue and dull right upper abdominal pain. This is due to the stretching of Gleason’s capsule. It can also cause a mild elevation of liver enzymes.
Since no specific blood tests are available to diagnose fatty liver, other types of liver disease will need to be ruled out. This includes testing for alcohol intake, as well as blood tests to rule out Hep B, Hep C, and Wilson’s Disease. Medication history in the patient will help rule out drug reaction.
Usually, fatty liver is diagnosed by an imaging study. On abdominal ultrasound, the liver has increased echo patterns suggestive of increased hepatic density. More specific tests include a FibroScan, which measures liver density. Although not always necessary, liver biopsy can confirm the diagnosis and severity of the liver disease.
Fatty liver itself does not cause any significant liver dysfunction. It does, however, indicate significant metabolic problems, including an increased risk of developing diabetes, hypertension, and heart disease. However, fatty liver can progress into nonalcoholic steatohepatitis (NASH).
On liver biopsy, NASH looks just like an alcoholic liver disease with increased fat and fibrosis. If this occurs, consultation with a GI specialist is recommended. NASH can progress to cirrhosis, which is end-stage liver disease. Even without progression to cirrhosis, the development of liver cancer (HCC) is increased. Even with the high prevalence of fatty liver, the development of HHC will substantially increase in this country.
Although the treatment of fatty liver is an intense research area, no drug therapy is currently available. Obeticholic acid (OCA) is in phase three trials and shows promise. It has significant side effects such as pruritis and elevation of cholesterol, which may limit its use. If the patient is obese, a limited weight loss of 10% body weight can reverse fibrosis. Although no clinical trial has been published, low-dose aspirin may be of benefit as it can decrease the development of liver cancer.
Fatty liver is now the most common cause of liver disease in this country. Consultation with a GI specialist or liver specialist is recommended for further evaluation and treatment options.