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NASH/AIH combo

Posted by shelby on May 25, 1999 at 16:12:54
I have a very general question.  Can you have a combination of Autoimmune Hepatitis and NASH?  If so, can you tell by the biopsy.  My biopsy said cirrhosis with moderate active inflammation and mild fatty changes.  I also have a positive ANA.
Can NASH alone cause cirrhosis?  All other hepatitis tests were negative like A,B,C etc.  The ANA test by the way is the only autoimmune test that was off according to the doctors. ANA 1:320.
I don't drink or smoke.
Thanks for any information in advance.
Do you consider NASH a serious disorder?

Posted by HFHSM.D.-D.M. on May 28, 1999 at 15:49:02

Dear shelby:
I was intrigued by your questions.  It sounds like you have an interesting set of clinical and biopsy findings.  let me try to make a few helpful comments.
NASH does not typically cause cirrhosis but it can cause cirrhosis.  We do consider it a serious condition and we try to get our patients with NASH to lower their cholesterol, control their diabetes and lose weight to the degree that those things are appropriate.  
However, you do have a positive ANA and the possibility of autoimmune hepatitis has to be considered.  This condition is somewhat more likely to cause cirrhosis.  
The critical thing is that there should be more information available from the biopsy than you are giving me.  The two conditions have different appearances and different sort of inflammation.  I would like to think the biopsy can give you a little more direction than you currently have.  You might ask that the biopsy slides be read by individuals with a lot of experience with liver disease (either pathologists or hepatologists).
The distinction between NASH and autoimmune hepatitis is critical because autoimmune hepatitis is often treated with steroids which can typically make NASH worse.  It sounds like you have cirrhosis, which means your liver disease is serious and sorting out the cause will be important.  
I hope this information is helpful to you. Again feel free to let us know of additional questions or information.  You can always contact us directly at Henry Ford at (313) 916-8865.  If you are in the Detroit area, we would always welcome to come see us.  We have a very active group of liver specialists and see many patients with autoimmune hepatitis.  We also have a very active liver transplant program.  
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  
Posted by sherrie on June 18, 1999 at 17:01:56
I am a 52 year old female.  I do not drink or smoke and I am approximately 20 lbs. overweight.  Had a blood test for a physical and elevated liver enzymes were noted.  I went to a gastroenterologist specializing in liver and she examined me as well as asked me detailed questions about my nutrition.  She suspected that I had NASH but before a liver biopsy she wanted me to watch my diet and check the levels in 6 weeks.  I was very careful and the levels responded to a better diet.  They came down somewhat.  She then said let's repeat bloodwork in 6 more weeks and the levels came down again.  Since then I realized that NASH was probably a correct diagnosis and it was responding to diet, I considered myself lucky and have not been back for followups.  My diet has gone steadily downhill and I occasionally have upper right quadrant pain.  Just an intermittent throbbing at times.  I do notice that the pain seems to occur right after I've ingested fatty foods. Have not had a liver biopsy.
Can I be reasonably sure that the NASH diagnosis is correct? And does the pain mean that it has progressed and that I have only minutes left to live?  I realize that the only way to make a definite diagnosis is to have a biopsy but my doctor seemed sure that it was NASH.  Please answer ASAP if possible because although I seem like I may have my head together, I'm a nervous wreck.  thank you very much.

Posted by HFHSM.D.-D.M. on June 27, 1999 at 21:42:07

Dear Sherrie:
Well the one thing I can tell you is that if you do have NASH, you won
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