Concurrence of Histologic Features of Steatohepatitis with Other Forms of Chronic Liver Disease

Abstract

Steatohepatitis, of either alcoholic or nonalcoholic etiologies, is ultimately diagnosed by clinicalpathologic correlation and is characterized histologically by lesions that differ from the portal-based chronic inflammation and fibrosis of most other forms of chronic liver disease. With the increasing prevalence of steatohepatitis in our society, it is likely that some patients will have coexistent clinical and/or histopathologic findings of steatohepatitis concurrently with another form of liver disease. The aim of this study was to document clinical and histologic findings in biopsies in an academic referral center. Ninety-three non-allograft liver biopsies with lesions of both steatohepatitis and another liver disease were retrospectively identified in 85 patients. The finding of coexisting disease represented 5.5% of all hepatitis C biopsies and 4.0% of other forms of chronic liver disease in the 34 month time period. Clinical chart review of patients with concurrent disease showed the following: Group 1, patients with hepatitis C (n ‫؍‬ 54); Group 2, patients with hepatitis C and prior or current history of more than 80 g/d alcohol consumption (n ‫؍‬ 20); Group 3, patients with other forms of chronic liver disease (n ‫؍‬ 11). Groups 1 and 3 had <10 g/d alcohol use. Obesity (body mass index >30) was noted in 75%, 60%, and 33% respectively, while 94%, 87% and 100% of patients were considered overweight (body mass index > 25). Diabetes was reported in 35%, 25%, and 9%. The concurrence of clinical and histologic features of steatohepatitis with another chronic liver disease may be a reflection of the frequency of steatohepatitis in the population at large.

The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…Because of the high prevalence of risk factors for NAFLD and NASH, it is not uncommon for patients with other chronic liver diseases to exhibit coexisting histological features of NAFLD ( 168 ). Coexistent hepatic steatosis is common in chronic hepatitis C (HCV) infection and is strongly associated with more advanced liver disease ( 169 -171 ).…”

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…Because of the high prevalence of risk factors for NAFLD and NASH, it is not uncommon for patients with other chronic liver diseases to exhibit co-existing histological features of NAFLD. 168 Coexistent hepatic steatosis is common in chronic hepatitis C (HCV) infection and is strongly associated with more advanced liver disease. [169][170][171] Another large study showed high prevalence of steatosis (40.5%) and steatohepatitis (15%) in patients with primary biliary cirrhosis (PBC), 172 although at least some of the steatosis and steatohepatitis in that study was suspected to be due to alcohol consumption.…”

Steatosis and Chronic Hepatitis C Infection: Mechanisms and Significance

“…In fact, the presence of co-existent nonalcoholic steatohepatitis, the more aggressive form of NAFLD, is found in 5%-10% of biopsy specimens from patients with CHC. 12,13 The etiology of hepatic steatosis in patients with NAFLD appears to be centered on both peripheral and hepatic insulin resistance. Increased energy stores occurring in obese individuals lead to enhanced lipolysis and generation of free fatty acids.…”