What is it? Steatohepatitis

Steatohepatitis is a chronic condition characterized by the development of inflammatory infiltration of the liver parenchyma in the context of hepatic cell fatty degeneration.

About the Disease

In practically every second patient with this diagnosis, the development of the disease is associated with metabolic disorders, primarily obesity and insulin resistance (insensitivity of target cells to circulating insulin). In 40-45% of cases, the disease can develop against the background of excessive alcohol consumption (alcoholic steatohepatitis). And only in 5% of patients is the pathology associated with the intake of medications. Cytostatic drug methotrexate, antiestrogen tamoxifen, and antiepileptic valproate group pose particular dangers. In some cases, the disease develops due to the combined action of several causes (mixed variant). Steatohepatitis in most cases is asymptomatic. Some patients may have minimal clinical manifestations – slight pain in the right hypochondrium and general weakness. The disease is usually diagnosed incidentally when elevated levels of liver enzymes are detected during biochemical blood analysis. The next step in diagnosis is the ultrasound assessment of the liver’s condition. However, in patients with obesity or at the initial stage of the disease, ultrasound is not very informative, and MRI is required. Treatment is primarily aimed at lifestyle modification. Drug therapy is secondary and aims to control the inflammatory reaction and prevent fibrosis.


According to the accepted classification, two groups of steatohepatitis are distinguished:

  1. Alcoholic – associated with excessive alcohol consumption;
  2. Non-alcoholic, which can develop against the background of metabolic disorders or be the result of the hepatotoxic action of certain medications.

Symptoms of Steatohepatitis

Most patients with steatohepatitis are asymptomatic. Sometimes nonspecific symptoms such as weakness, discomfort, or mild pain localized in the right hypochondrium may occur. Typically, the clinical picture highlights symptoms that are manifestations of metabolic syndrome, such as visceral obesity (accumulation of fat in the abdominal area), dyslipidemia, arterial hypertension, and signs of glucose metabolism disorder.


What is steatohepatitis from the point of view of causative factors? According to etiological signs, metabolic, alcoholic, and drug variants are distinguished. Risk factors for steatohepatitis include:

  • Genetic features (carrying certain genes – PNPLA3, TM6SF2);
  • Excess fat tissue in the body exceeding normative values;
  • Metabolic syndrome – a combination of insulin resistance, obesity, arterial hypertension, and elevated cholesterol levels;
  • Tobacco smoking;
  • Prolonged high blood glucose levels;
  • Long-standing hyperlipidemia.


The diagnosis of steatohepatitis is aimed not only at verifying fatty hepatosis associated with inflammation but also at identifying the etiological factor of the disease. During palpation and percussion of the abdomen, in the absence of obesity in the patient, it is easy to determine enlargement of the liver and spleen, as well as the presence of ascites, which may indicate the formation of liver cirrhosis. On examination of the skin, small liver signs can be detected (petechiae in the form of stars, red palms, gynecomastia in men). Laboratory methods that allow establishing the diagnosis include an increase in the levels of ALT and AST enzymes in the blood (usually indicators are 2-3 times higher than normal). The activity of alkaline phosphatase and gamma-glutamyl transpeptidase may also increase. The examination plan includes assessing the glycemic profile – determining fasting glucose levels, glycated hemoglobin, and, if necessary, conducting a glucose tolerance test to detect hidden insulin resistance. Identification of liver fatty degeneration is carried out using radiological diagnostic methods.

Ultrasound scanning is used as a screening method. Signs indicating the disease include:

  • moderate enlargement of the liver;
  • decreased echogenicity of the parenchyma (the so-called “bright” liver effect);
  • impoverishment or absence of visualization of the vascular pattern;
  • “damping” of the ultrasound beam. However, in cases where the sensitivity of ultrasound is limited (fatty degeneration is less than 20% or severe obesity), MRI is advisable. This method has greater sensitivity than ultrasound of the abdominal organs, especially in diagnosing moderate hepatic steatosis. Indirect elastography, which is based on the property of mechanical wave oscillation propagating at different speeds in media with different densities, is also highly informative. With the formation of fibrosis areas, the density of liver parenchyma increases, which is reflected in higher elasticity values. It should be noted that the “gold standard” for diagnosing steatohepatitis is liver biopsy. However, due to its invasiveness and the possibility of assessing only a limited biopsy sample of liver tissue, the use of this type of examination in clinical practice is limited.

Treatment of Steatohepatitis

According to clinical recommendations, the treatment of steatohepatitis begins with lifestyle modification. The second direction is the prescription of drug therapy.

Conservative treatment

In steatohepatitis of both maximum and minimum activity, the key link in therapy is improving dietary behavior and, consequently, reducing excess weight. Lifestyle modification also involves increasing physical activity. Sedentary behavior is a proven risk factor for the development of obesity, insulin resistance, metabolic syndrome, and hepatic steatosis. For patients with alcoholic steatohepatitis, complete abstinence from alcohol consumption is crucial, leading to an improvement in the prognosis of the disease course. Correction of vitamin B deficiencies, primarily thiamine and pyridoxine, as well as adequate nutrition, is necessary. Achieving adequate protein intake promotes liver cell regeneration and improves metabolic processes in the liver parenchyma. Prolonged complete abstinence from alcohol leads to regression of liver fibrosis, and in cases of already developed cirrhosis, a decrease in portal vein pressure occurs. In drug-induced steatohepatitis, the basis of treatment is discontinuation of the causally significant drug. Typically, this measure leads to a regression of steatohepatitis manifestations in the medium term. In the pharmacotherapy of steatohepatitis, an important role is assigned to drugs that improve the functional state of the liver and, consequently, the prognosis of the disease. Such drugs include ursodeoxycholic acid preparations. These agents help protect liver cells, modulate the immune response, and reduce the degree of connective tissue proliferation.

Surgical treatment

Surgical treatment (liver transplantation) can only be considered in cases of cirrhotic transformation of the liver against the background of steatohepatitis.

The following measures can reduce the risk of liver steatosis and subsequent inflammation:

  • maintaining weight within normal limits;
  • maintaining physical activity at a level of at least 150 minutes per week;
  • rational and balanced nutrition;
  • abstaining from alcoholic beverages or consuming them within permissible limits;
  • taking medication only as prescribed by a doctor.