Cardiovasculaire Geneeskunde.nl

Hepatologists' overview of hepatic steatosis

Slides (presentatie) - Mar. 25, 2010

Hepatologists' Overview of Hepatic Steatosis

Hepatologists' Overview of Hepatic Steatosis

Structure

Laparoscopic view of a fatty liver

Definitions

NAFLD—History

Spectrum of NAFLD

NASH

Conditions Associated with NAFLD

NASH—Risk Factors

Metabolic syndrome

Obesity prevalence in Netherlands

NAFLD prevalence

Pathogenesis of NASH

Pathogenesis of NASH (1) - Induction of insulin resistance

Pathogenesis of NASH (2) - Induction of inflammation

Pathogenesis: “2 Hit” Paradigm

Diagnostic strategy

NAFLD—Laboratory Findings

Liver biopsy in NASH

Pathology NAFLD vs NASH

Pathology NAFLD vs NASH

NAFLD—Imaging

Steatosis on ultrasound

Natural History of NAFLD

Impact of NAFLD on survival

Independent predictors of fibrosis progression

Therapeutic options in NAFLD

Weight loss & Exercise

Bariatric Surgery

Surgery for NASH

Bariatric surgery improves hepatic steatosis

Bariatric surgery improves hepatic fibrosis

Bariatric surgery improves steatohepatitis

Bariatric surgery for non-alcoholic steatohepatitis in obese patients.

Liver Transplantation

Liver Transplantation

Pathogenesis of NASH with Potential Sites for Therapy

Medical treatment for NASH

Antihyperlipidemics

Statins

Metformin

Metformin in non-diabetic NASH

Thiazolidinediones

Insulin senzitizers in NASH

Ursodeoxycholic acid

Antioxidants:Vitamin E

PIVENS Trial

PIVENS

Therapy for NASH

Conclusion

Treatment “algoritm”

Management

Conclusion

Despite a number of RCT’s no drug has shown to improve all important outcome measures No drug can be recommended at this stage

Treatment of NASH Cirrhosis 3. Insulin Resistance Treatment

Fibrates

Metformin in non-diabetic NASH

Orlistat

Metformin Trials

Treatment of NASH Cirrhosis 4. Liver-specific therapies

Slide 62

Background

6-Ethyl Chenodeoxycholic Acid - INT-747 Semi-Synthetic Derivative of CDCA

Hypothesis

Eligibility criteria

Type 2 Diabetes + NAFLD Exploratory Study

Enrichment of INT-747 of serum Bile Acids- day 43

% Δ Weight – All Patients

Change in ELF Test Score – Day 0 to 43

Aminotransferases

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Laparoscopic view of a fatty liver

NAFLD-NASH Prevalence

Slide 77

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