Published online Jun 18, 2015. doi: 10.4254/wjh.v7.i11.1450
Peer-review started: August 25, 2014
First decision: November 3, 2014
Revised: April 18, 2015
Accepted: April 28, 2015
Article in press: April 30, 2015
Published online: June 18, 2015
Processing time: 297 Days and 0.4 Hours
There is worldwide epidemic of non-alcoholic fatty liver disease (NAFLD). NAFLD is a clinical entity related to metabolic syndrome. Majority of the patients are obese but the disease can affect non-obese individuals as well. Metabolic factors and genetics play important roles in the pathogenesis of this disorder. The spectrum of disorders included in NAFLD are benign macrovesicular hepatic steatosis, non-alcoholic steatohepatitis, hepatic fibrosis, cirrhosis of liver and hepatocellular carcinoma. Although the disease remains asymptomatic most of the time, it can slowly progress to end stage liver disease. It will be the most common indication of liver transplantation in the future. It is diagnosed by abnormal liver chemistry, imaging studies and liver biopsy. As there are risks of potential complications during liver biopsy, many patients do not opt for liver biopsy. There are some noninvasive scoring systems to find out whether patients have advanced hepatic fibrosis. At the present time, there are limited treatment options which include lifestyle modification to loose weight, vitamin E and thioglitazones. Different therapeutic agents are being investigated for optimal management of this entity. There are some studies done on incretin based therapies in patients with NAFLD. Other potential agents will be silent information regulator protein Sirtuin and antifibrotic monoclonal antibody Simtuzumab against lysyl oxidase like molecule 2. But they are still in the investigational phase.
Core tip: While non-alcoholic fatty liver disease is a very common clinical problem in our day-to-day clinical practice, the management of this disease is still in its infancy. This article focuses on the epidemiology, pathogenesis, pathology, clinical presentation, investigations including noninvasive scoring systems, current treatment options and future potential agents.