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Medline ® Abstract for Reference 35

of 'Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis'

Comparison of clinical, biochemical and histological features of alcoholic steatohepatitis and non-alcoholic steatohepatitis in Asian Indian patients.
Singh DK, Rastogi A, Sakhuja P, Gondal R, Sarin SK
Indian J Pathol Microbiol. 2010 Jul;53(3):408-13.
BACKGROUND: Alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH) are significant forms of liver disease and may progress to end-stage liver disease, cirrhosis and potentially malignant complications. The most difficult aspect of establishing a diagnosis of NASH is distinguishing it from ASH. Laboratory markers such as AST, ALT and GGT lack sufficient sensitivity and specificity.
AIM: To study the clinical, biochemical and histological differences between non-alcoholic steatohepatitis (NASH) and alcoholic steatohepatitis (ASH).
MATERIALS AND METHODS: Sixty histologically confirmed cases of non-alcoholic steatohepatitis and 38 cases of alcoholic steatohepatitis were included in the study. A modified form of scoring system proposed by Yip and Burt was used to grade histological features of NASH and ASH.
RESULTS: Mean age was 42.85 +/- 12.36 years in ASH group and 35.07 +/- 8.06 years for NASH group. Male: Female ratio was 37:1 in ASH and 4:1 in NASH. The mean ALT (P = 0.012), SAP (P = 0.003), serum bilirubin (P = 0.001), AST/ALT ratio (P = 0.03), steatosis (P<0.001), ballooning degeneration of hepatocytes (P<0.001), portal inflammation (P<0.001), Mallory hyaline (P = 0.001), ductular proliferation and fibrosis (P<0.001) showed a significant difference between ASH and NASH cases.
DISCUSSION: Older age, male sex, larger derangement of serum biochemistry, high serum bilirubin, AST/ALT>1, more ballooning degeneration, portal inflammation, Mallory's hyaline, hepatocytic and ductular cholestasis, ductular proliferation and higher stage of fibrosis favors a diagnosis of ASH. Younger age, high ALT, AST/ALT<1, higher grade of steatosis and absence of extensive neutrophilic portal inflammation favors a diagnosis of NASH.
Department of Pathology, G B Pant Hospital, Delhi, India.