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NASH - Nonalcoholic steatohepatitis
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NASH - Nonalcoholic steatohepatitis

I was diagnosed with N.A.S.H. (Nonalcoholic steatohepatitis), back in 2003, considered a Grade 3 of 4.
I was also diagnosed with Gilbert's Syndrome, in 2008.

I have a new PCP (as of January 2012), who doesn't seem to take either one, very seriously.

What should I read from this?

-- Socrates2k1 (aka Stan)
Tags: NASH, Steatohepatitis, Nonalcoholic Steatohepatitis, Gilbert's Syndrome
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From what I have read Gilbert's Syndrome is a benign condition and is not indicative of a liver problem.

Gilbert's does cause an elevated Indirect Bilirubin. Indirect Bilirubin is not liver related but when it is elevated it may cause your Total Bilirubin (your Indirect Bilirubin + your Direct Bilirubin = Total Bilirubin) to be elevated.

I mention this because usually only the Total Bilirubin is shown on blood test results. If your Total Bilirubin was elevated it would not be clear whether the elevation was due to your NASH (Direct Bilirubin) or your Gilbert's (Indirect Bilirubin). A "fractionalized bilirubin test" breaks Total Bilirubin down and gives a separate value for Direct and Indirect Bilirubin.

NASH is a liver disease which can, in a minority of patients, develop into cirrhosis. Liver disease should probably not be managed by a PCP. The ideal physician to treat you is a hepatologist (liver specialist). Hepatologists can usually be found at the larger hospitals and particularly at teaching hospitals. I looked around and was unable to find any hepatologists located in Wichita but I did see some gastroenterologists which would be the next best choice if there aren't any hepatologists available.


"NONALCOHOLIC STEATOHEPATITIS PROGNOSIS

NASH is typically a chronic condition (ie, it persists for many years). It is difficult to predict the course of NASH in an individual. Few factors have been useful in predicting the course of this condition, although features in the liver biopsy can be helpful.

The good news is most people with NASH will not develop serious liver problems. One study showed that most people with NASH live as long as those without it. Furthermore, liver function tests are stable over time in most people with NASH.

However, NASH can progress in some people. One study that tracked liver damage over time showed that the condition improved in about 3 percent of people, remained stable in 54 percent of people, and worsened in 43 percent of people [1].

The most serious complication of NASH is cirrhosis, which occurs when the liver becomes severely scarred. In one study, between 8 and 26 percent of people with NASH developed cirrhosis [1]. Older diabetic women may be at increased risk. (See "Patient information: Cirrhosis (Beyond the Basics)".)..."

http://www.uptodate.com/contents/patient-information-nonalcoholic-steatohepatitis-nash-beyond-the-basics

I'm sure you've read that the primary approach to NASH is gradual weight loss and treatment/management of diabetes and insulin resistance.

There is also some evidence that Vitamin E may be beneficial for NASH patients.

"Initial results show NASH improved with vitamin E
Charles C. Chante, MD (The Philippine Star) Updated March 04, 2012

Patients on 800 IU of vitamin E daily showed  better liver function and decreased cytologic ballooning

The use of vitamin E supplements by patients with nonalcoholic steatohepatitis was associated with a greater improvement in nonalcoholic fatty liver disease activity scores and cytologic ballooning, compared with the use of pioglitazone of placebo, results from a randomized controlled trial showed....."

http://www.philstar.com/Article.aspx?articleId=783512
publicationSubCategoryId=64

The Vitamin E studies are still preliminary but if a credible physician says it can't hurt you then maybe it's something you could try.

Good luck Stan,
Mike
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Avatar_m_tn
From what I have read Gilbert's Syndrome is a benign condition and is not indicative of a liver problem.

Gilbert's does cause an elevated Indirect Bilirubin. Indirect Bilirubin is not liver related but when it is elevated it may cause your Total Bilirubin (your Indirect Bilirubin + your Direct Bilirubin = Total Bilirubin) to be elevated.

I mention this because usually only the Total Bilirubin is shown on blood test results. If your Total Bilirubin was elevated it would not be clear whether the elevation was due to your NASH (Direct Bilirubin) or your Gilbert's (Indirect Bilirubin). A "fractionalized bilirubin test" breaks Total Bilirubin down and gives a separate value for Direct and Indirect Bilirubin.

NASH is a liver disease which can, in a minority of patients, develop into cirrhosis. Liver disease should probably not be managed by a PCP. The ideal physician to treat you is a hepatologist (liver specialist). Hepatologists can usually be found at the larger hospitals and particularly at teaching hospitals. I looked around and was unable to find any hepatologists located in Wichita but I did see some gastroenterologists which would be the next best choice if there aren't any hepatologists available.


"NONALCOHOLIC STEATOHEPATITIS PROGNOSIS

NASH is typically a chronic condition (ie, it persists for many years). It is difficult to predict the course of NASH in an individual. Few factors have been useful in predicting the course of this condition, although features in the liver biopsy can be helpful.

The good news is most people with NASH will not develop serious liver problems. One study showed that most people with NASH live as long as those without it. Furthermore, liver function tests are stable over time in most people with NASH.

However, NASH can progress in some people. One study that tracked liver damage over time showed that the condition improved in about 3 percent of people, remained stable in 54 percent of people, and worsened in 43 percent of people [1].

The most serious complication of NASH is cirrhosis, which occurs when the liver becomes severely scarred. In one study, between 8 and 26 percent of people with NASH developed cirrhosis [1]. Older diabetic women may be at increased risk. (See "Patient information: Cirrhosis (Beyond the Basics)".)..."

http://www.uptodate.com/contents/patient-information-nonalcoholic-steatohepatitis-nash-beyond-the-basics

I'm sure you've read that the primary approach to NASH is gradual weight loss and treatment/management of diabetes and insulin resistance.

There is also some evidence that Vitamin E may be beneficial for NASH patients.

"Initial results show NASH improved with vitamin E
Charles C. Chante, MD (The Philippine Star) Updated March 04, 2012

Patients on 800 IU of vitamin E daily showed  better liver function and decreased cytologic ballooning

The use of vitamin E supplements by patients with nonalcoholic steatohepatitis was associated with a greater improvement in nonalcoholic fatty liver disease activity scores and cytologic ballooning, compared with the use of pioglitazone of placebo, results from a randomized controlled trial showed....."

http://www.philstar.com/Article.aspx?articleId=783512
publicationSubCategoryId=64

The Vitamin E studies are still preliminary but if a credible physician says it can't hurt you then maybe it's something you could try.

Good luck Stan,
Mike
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211940_tn?1267884866
Mike,

Thank you, very much, for all the helpful information.

I will certainly ask my PCP, to recommend one, when I see him (3/28).

-- Socrates2k1 (aka Stan)
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2035635_tn?1332520375
I too was diagnosed with NASH.  I was originally diagnosed in 2006 and 3 weeks ago was told that it had progressed into cirrhosis.  If I can offer any advice to you it is this.  Start eating fruits and vegetables now.  Avoid alcohol and fatty foods.  I don't know what your diet is now but I have had to change my substantially since my diagnosis so we could try and slow its progression.  Also, I was told milk thistle is very good for the liver.  It can't hurt the liver so I am trying it.  The best advice I have recieved thus far is this, "be mindful of everything you put into your mouth.  The first organ that food, drink or medicines come across is the liver.  The goal of anyone with liver issues is to reduce the amount of work and stress on it."
     At this point, you can stop the progression of NASH.  I didn't change my habits until it was too late.  Change the causes of stress on your liver while you can.  Good luck and God Bless.  Tom
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