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Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH.
Dig Dis 2015; 33(4):598-607DD

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and comprises a liver disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) with risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Associated metabolic conditions and comorbidities such as obesity, diabetes and cardiovascular diseases are common and require concerted management. Adiponutrin (PNPLA3) variants may help to identify NAFLD patients at higher risk for liver disease progression towards advanced fibrosis and HCC. The therapeutic options in NAFLD/NASH include lifestyle modification, pharmacological treatment, bariatric surgery for patients with morbid obesity and treatment of complications of liver cirrhosis and HCC, including liver transplantation. Insulin sensitizers and antioxidative treatment strategies with vitamin E are among the best-established pharmacological approaches, but both drugs have long-term safety issues and there is limited evidence in cirrhotic patients. Treatment of concomitant/underlying metabolic conditions with statins or metformin may also have beneficial effects on portal hypertension, complications of liver cirrhosis and HCC prevention. The bile acid receptor FXR may be a promising novel therapeutic target for the treatment of NAFLD/NASH, fibrosis and portal hypertension, but the prognostic implications of associated changes in low- and high-density lipoprotein cholesterol require further studies. Morbidly obese NASH patients can benefit from bariatric surgery which may reduce liver fibrosis but carries a risk of decompensation in patients with advanced liver cirrhosis. When carefully selected, patients with NASH cirrhosis undergoing liver transplantation have a good outcome. This review summarizes recent progress in the management of patients with liver cirrhosis due to NASH.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

26159280

Citation

Traussnigg, Stefan, et al. "Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients With Cirrhosis Due to NAFLD and NASH." Digestive Diseases (Basel, Switzerland), vol. 33, no. 4, 2015, pp. 598-607.
Traussnigg S, Kienbacher C, Halilbasic E, et al. Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH. Dig Dis. 2015;33(4):598-607.
Traussnigg, S., Kienbacher, C., Halilbasic, E., Rechling, C., Kazemi-Shirazi, L., Hofer, H., ... Trauner, M. (2015). Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH. Digestive Diseases (Basel, Switzerland), 33(4), pp. 598-607. doi:10.1159/000375353.
Traussnigg S, et al. Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients With Cirrhosis Due to NAFLD and NASH. Dig Dis. 2015;33(4):598-607. PubMed PMID: 26159280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH. AU - Traussnigg,Stefan, AU - Kienbacher,Christian, AU - Halilbasic,Emina, AU - Rechling,Christian, AU - Kazemi-Shirazi,Lili, AU - Hofer,Harald, AU - Munda,Petra, AU - Trauner,Michael, Y1 - 2015/07/06/ PY - 2015/7/11/entrez PY - 2015/7/15/pubmed PY - 2016/4/5/medline SP - 598 EP - 607 JF - Digestive diseases (Basel, Switzerland) JO - Dig Dis VL - 33 IS - 4 N2 - Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and comprises a liver disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) with risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Associated metabolic conditions and comorbidities such as obesity, diabetes and cardiovascular diseases are common and require concerted management. Adiponutrin (PNPLA3) variants may help to identify NAFLD patients at higher risk for liver disease progression towards advanced fibrosis and HCC. The therapeutic options in NAFLD/NASH include lifestyle modification, pharmacological treatment, bariatric surgery for patients with morbid obesity and treatment of complications of liver cirrhosis and HCC, including liver transplantation. Insulin sensitizers and antioxidative treatment strategies with vitamin E are among the best-established pharmacological approaches, but both drugs have long-term safety issues and there is limited evidence in cirrhotic patients. Treatment of concomitant/underlying metabolic conditions with statins or metformin may also have beneficial effects on portal hypertension, complications of liver cirrhosis and HCC prevention. The bile acid receptor FXR may be a promising novel therapeutic target for the treatment of NAFLD/NASH, fibrosis and portal hypertension, but the prognostic implications of associated changes in low- and high-density lipoprotein cholesterol require further studies. Morbidly obese NASH patients can benefit from bariatric surgery which may reduce liver fibrosis but carries a risk of decompensation in patients with advanced liver cirrhosis. When carefully selected, patients with NASH cirrhosis undergoing liver transplantation have a good outcome. This review summarizes recent progress in the management of patients with liver cirrhosis due to NASH. SN - 1421-9875 UR - https://www.unboundmedicine.com/medline/citation/26159280/Challenges_and_Management_of_Liver_Cirrhosis:_Practical_Issues_in_the_Therapy_of_Patients_with_Cirrhosis_due_to_NAFLD_and_NASH_ L2 - https://www.karger.com?DOI=10.1159/000375353 DB - PRIME DP - Unbound Medicine ER -