Steatohepatitis

Overview
Steatohepatitis is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver ("steato", meaning fat, "hepatitis", meaning inflammation of the liver). Classically seen in alcoholics, steatohepatitis also is frequently found in people with diabetes and obesity. When not associated with excessive alcohol intake, it's referred to as "non-alcoholic steatohepatitis", or NASH. Steatohepatitis of either etiology may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies).

Steatohepatitis is characterized microscopically by hepatic fat accumulation (steatosis), mixed lobular inflammation, ballooning degeneration of hepatocytes (sometimes with identifiable Mallory bodies), glycogenated hepatocyte nuclei, and pericellular fibrosis. The "chicken wire" pattern of the pericellular fibrosis, which affects portal areas only secondarily in later stages, is very characteristic and is identified on trichrome stains.

Treatment
Recent studies suggest that diet, exercise, and especially antiglycemic drugs may alter the course of the disease. A randomized controlled trial found that "pioglitazone led to metabolic and histologic improvement in subjects with nonalcoholic steatohepatitis".

Prognosis
A retrospective cohort study concluded that "liver failure is the main cause of morbidity and mortality in NASH-associated cirrhosis. The prognosis is either similar or less severe than HCV-cirrhosis."