Forty-five patients completed 6 months of therapy without significant side effects. Vitamin treatment resulted in a statistically significant improvement in fibrosis score (p=0.002). No changes were noted in inflammation with treatment. Vitamin E and vitamin C, in the doses used in this study, were well tolerated and were effective in improving fibrosis scores in NASH patients. No improvement in necroinflammatory activity or ALT was seen with this combination of drug therapy. A larger, multicenter, longer-term trial with vitamin E and vitamin C seems to be warranted.

SUMMARYBackground: Treatment options for non-alcoholic steatohepatitis (NASH) are limited. Weight loss remains the most recommended therapy. Orlistat is an effective adjunct to dietary weight loss therapy. Aim: To evaluate the efficacy of orlistat, given for 6 months to patients with obesity and biopsy confirmed NASH. Methods: Ten obese patients with biopsy proven NASH were enrolled. Orlistat was given with meals for 6 months. Body Mass Index (BMI), liver enzymes, haemoglobin A 1c , fasting lipids and glucose were assessed at baseline and at completion of the study. Paired liver histology was obtained. Results: Six women and four men were enrolled. The mean weight loss was 22.7 lb and ranged from 0 to

NASH has a variable histological course. However, one third of patients have fibrosis progression, and one third of these have rapid progression to advanced fibrosis. Histological progression correlated with higher serum AST but no other clinical factors. Steatosis alone may progress to NASH with fibrosis.

Some NAFL patients may have alcohol fatty liver disease instead. Routine physician interviews obtain less accurate alcohol histories compared to CLDH. The clinical significance of past alcohol intake and methods of measuring alcohol ingestion in fatty liver patients deserves further investigation.