Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb;29(Suppl):S228-S243.
doi: 10.3350/cmh.2022.0401. Epub 2022 Dec 14.

Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis

Yi-Wen Shi  1 , Jian-Gao Fan  1
Affiliations
Review

Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis

Yi-Wen Shi et al. Clin Mol Hepatol. 2023 Feb.

Abstract

Nonalcoholic steatohepatitis (NASH) is an aggressive form of nonalcoholic fatty liver disease (NAFLD) characterized by steatosis-associated inflammation and liver injury. Without effective treatment or management, NASH can have life-threatening outcomes. Evaluation and identification of NASH patients at risk for adverse outcomes are therefore important. Key issues in screening NASH patients are the assessment of advanced fibrosis, differentiation of NASH from simple steatosis, and monitoring of dynamic changes during follow-up and treatment. Currently, NASH staging and evaluation of the effectiveness for drugs still rely on pathological diagnosis, despite sample error issues and the subjectivity associated with liver biopsy. Optimizing the pathological assessment of liver biopsy samples and developing noninvasive surrogate methods for accessible, accurate, and safe evaluation are therefore critical. Although noninvasive methods including elastography, serum soluble biomarkers, and combined models have been implemented in the last decade, noninvasive diagnostic measurements are not widely applied in clinical practice. More work remains to be done in establishing cost-effective strategies both for screening for at-risk NASH patients and identifying changes in disease severity. In this review, we summarize the current state of noninvasive methods for detecting steatosis, steatohepatitis, and fibrosis in patients with NASH, and discuss noninvasive assessments for screening at-risk patients with a focus on the characteristics that should be monitored at follow-up.

Keywords: Disease progression; Nonalcoholic steatohepatitis; Noninvasive diagnosis; Risk stratification; Treatment efficacy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Evaluation approaches for different trial phases and different stages of NASH. Specific sets of evaluation tools should be used for different phases of NASH. Different assessments are also required for patients with different stages of NASH. MRE, magnetic resonance elastography; MRI-PDFF, magnetic resonance imaging-proton density fat fraction; NASH, nonalcoholic steatohepatitis; NAS, NASH activity score; AEs, adverse events; CAP, controlled attenuation parameter; US, ultrasound; CK18, Cytokeratin 18; cT1, corrected T1; FLI, fatty liver index; HSI, hepatic steatosis index; FIB-4, fibrosis-4 index; LAP, lipid accumulation product; NFS, NAFLD fibrosis score; ELF test, enhanced liver fibrosis test; LSM, liver stiffness measurement; MELD score, model for end-stage liver disease score; HVPG, hepatic venous pressure gradient.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Afshar EE, et al. The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7:851–861. - PubMed
    1. Lee J, Kim T, Yang H, Bae SH. Prevalence trends of non-alcoholic fatty liver disease among young men in Korea: A Korean military population-based cross-sectional study. Clin Mol Hepatol. 2022;28:196–206. - PMC - PubMed
    1. Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020: The state of the disease. Gastroenterology. 2020;158:1851–1864. - PubMed
    1. Le MH, Yeo YH, Zou B, Barnet S, Henry L, Cheung R, et al. Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach. Clin Mol Hepatol. 2022;28:841–850. - PMC - PubMed
    1. Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: A review. JAMA. 2020;323:1175–1183. Erratum in: JAMA 2020;323:1619. - PubMed

MeSH terms