Peer-review started: May 21, 2020
First decision: August 22, 2020
Revised: September 19, 2020
Accepted: September 27, 2020
Article in press: September 27, 2020
Published online: October 28, 2020
Nonalcoholic steatohepatitis is a subtype of metabolic dysfunction-associated liver disease which has emerged as one of the most common causes of cirrhosis and liver transplantation in the United States and many western countries. The two leading risk factors associated with nonalcoholic steatohepatitis are obesity and insulin resistance with patients often demonstrating features of the metabolic syndrome. Histological improvement including arrest or improvement in fibrosis can occur in patients who are able to modify these risk factors when diagnosed early in the course of their disease. In addition to the development of cirrhosis and its life-threatening complications including hepatocellular carcinoma, variceal bleeding, ascites and hepatic encephalopathy, nonalcoholic steatohepatitis is also associated with coronary artery, carotid artery and peripheral vascular disease with coronary artery disease identified as the most common cause of death. Although multiple clinical trials evaluating a variety of medications targeted at different aspects in the pathogenesis and progression of nonalcoholic steatohepatitis have been completed and are still in progress, there is currently no approved treatment for this disease except for risk factor modification. This article will review the most recent and salient medical advances in the treatment of nonalcoholic steatohepatitis.
Core Tip: This review article discusses important advances in the medical treatment of nonalcoholic steatohepatitis. Initially considered to be a disease only affecting western countries, nonalcoholic steatohepatitis and obesity are increasing in prevalence worldwide. This review includes data from the most recent peer-reviewed journals in 2020 but does not include meeting abstracts or presentations.