Clinical and Biochemical Effects of Lifestyle Modification With Pentoxifylline, Vitamin E in Patients With Non-Alcoholic Steatohepatitis in Sulaimani

Abstract

Background 
 The burden of Non-Alcoholic Steatohepatitis is growing and current pharmacologic treatments are limited by adverse effects and inconsistent efficacy. Pilot studies suggest that Pentoxifylline and vitamin E can reduce degree and pattern of fatty liver, liver enzyme and inflammatory marker in patients with NASH. 
 Objectives 
 Evaluation of the clinical, biochemical and ultrasonographic effects of pentoxifylline, and vitamin E in patients with non-alcoholic steatohepatitis.
 Methods
 A total of 110 participants with NASH which diagnosed by ultrasonography fatty infiltration and raised aminotransferase level were included, only 90 participants completed the study. Demographic data, anthropometric measures such as Body Mass Index (BMI), waist/hip ratio were taken, liver function test, lipid profile, blood glucose, serum creatinine and High sensitivity C-reactive protein (Hs-CRP). The patients were divided into three comparable groups in age, gender and BMI. All enrolled participants were treated by lifestyle modification but pharmacologically they were randomly divided into three groups and followed for 6 months. Group 1; treated with placebo as a control group (starch prepared by capsule 400mg twice daily). Group 2; treated with vitamin E soft gelatin capsule 400 IU twice daily.Group 3; treated with pentoxifylline caplet 400mg twice daily.
 Results
 Out of 110 participants, only 90 participants (48 male, 42 female) completed this study, with age range of 23-65 years with age mean was 42.1±11.2. All the three groups showed decreased steatosis by ultrasonography and a significant reduction in aminotransferase levels, Hs-CRP, lipid profile, blood glucose, blood pressure and waist circumference compared to baseline. In the pentoxifylline group, side effects such as nausea, heartburn and dizziness were noted while in vitamin E group; abdominal pain and blurred vision were recorded after the second visit. 
 Conclusions
 Pentoxifylline or Vitamin E with dietary changes and exercise led to significant improvement in hepatic steatosis indicated by ultrasonography, reduction in aminotransferase levels and improved inflammatory marker (Hs-CRP).