Understanding Steatohepatitis: Causes, Symptoms, and Treatment

Steatohepatitis is a stage of a condition called fatty liver disease. Fatty liver disease occurs when your body stores fat around your liver. Fatty liver disease doesn’t always cause symptoms. When fatty liver disease is advanced enough to cause symptoms, it’s called steatohepatitis.

Your liver is inflamed in the steatohepatitis stage of fatty liver disease. This is in addition to the fat around your liver. Inflammation of your liver can cause damage to your liver and eventually lead to liver scarring and liver failure.

Alcoholic vs. nonalcoholic steatohepatitis

The primary difference between alcoholic and nonalcoholic steatohepatitis is the cause. The effects on your liver and the symptoms you experience are generally the same.

• Alcoholic steatohepatitis: Sometimes, steatohepatitis is the result of chronic and heavy alcohol use. This is called “alcoholic steatohepatitis.”
• Nonalcoholic steatohepatitis: Steatohepatitis also occurs in people who don’t drink alcohol or drink a minimal to moderate amount. In these people, the damage to their livers isn’t caused by alcohol. This is called “nonalcoholic steatohepatitis.”

But some research indicates that there might be additional differences. In biopsies, the livers of people with alcoholic steatohepatitis often show more damage than the livers of people with nonalcoholic steatohepatitis. It’s not clear whether this is because the damage is always greater in people with alcoholic steatohepatitis or whether it’s because biopsies are often done later in the course of treating alcoholic steatohepatitis. More research is needed on this topic.

There are multiple causes of steatohepatitis. The condition is primarily associated with chronic alcohol use, but nonalcoholic steatohepatitis is linked to multiple risk factors. For instance, obesity is considered to be one of the largest risk factors for nonalcoholic steatohepatitis.

Additional risk factors include:

• high cholesterol
• high triglycerides
• high blood sugar
• high blood pressure
• diabetes
• an underactive thyroid
• a diet lacking in nutrition
• a diet high in sugar and unhealthy fats
• polycystic ovary syndrome (PCOS)
• sleep apnea
• metabolic syndrome
• an underactive pituitary gland

Researchers don’t know why these factors lead to fatty liver disease and nonalcoholic steatohepatitis in some people but not in others. It’s possible there’s a genetic link, but this hasn’t been proven. In addition to medical risk factors, there are a few demographic risk factors for nonalcoholic steatohepatitis.

These include:

• being older than 40 years of age
• being postmenopausal
• having a Hispanic or Asian ethnic background

Symptoms of steatohepatitis can be mild and easy to miss. In some cases, you might not experience symptoms until your condition progresses further. Early symptoms commonly include:

• fatigue
• mild pain in the top right section of your abdomen
• weakness
• loss of appetite
• unexplained weight loss

As your condition progresses, it can cause further damage to your liver. This can include liver scarring. If this happens, you might have symptoms such as:

• frequent bleeding that’s hard to stop
• skin that bruises very easily
• the appearance of large and spider-like blood vessels under your skin
• nausea
• jaundice
• fluid buildup that causes swelling in your abdomen
• itchy skin
• swollen legs
• swollen feet
• slurred speech
• confusion
• drowsiness

The diagnostic process for steatohepatitis will begin with a medical exam. You and a doctor or healthcare professional will discuss your symptoms, your medical history, and your lifestyle. It’s important to be honest about your alcohol consumption. A doctor won’t judge you, but they’ll be able to make sure you’re getting the best treatment possible.

The doctor might order several tests to confirm a diagnosis of steatohepatitis. This commonly includes:

• Liver function test: A liver function test is a blood test that measures the levels of liver enzymes and other chemicals in your blood. This can help doctors measure how well your liver is working.
• Lipid panel: A lipid panel measures the levels of fats in your blood. People with steatohepatitis sometimes have elevated triglycerides.
• Fibrosis assessment: A fibrosis assessment is a test that can help doctors look for liver scarring.
• Ultrasound or CT scan: A doctor might order an ultrasound or CT scan to get a detailed look at your liver. This can help them see the amount of fat surrounding your liver and the level of inflammation.
• Magnetic resonance elastography (MRE): An MRE is an imaging test that combines an MRI and an ultrasound. This can be used to create an even more detailed image of your liver.
• Liver biopsy: A liver biopsy isn’t always necessary, but it can show a complete picture of your condition. A liver biopsy is done by inserting a long needle through your abdomen to withdraw a sample of liver tissue. This allows doctors to test the exact amount of fat, swelling, and damage.

There are no medications or standard medical treatments for steatohepatitis. The standard treatment is lifestyle changes. But depending on the underlying factors that are contributing to your steatohepatitis, medical treatments could also be needed.

For instance, you might need an adjustment to diabetes or blood pressure medication.

Lifestyle changes for steatohepatitis generally include:

• Reducing or stopping alcohol consumption: Additional alcohol consumption can further damage your liver. If you need help decreasing your alcohol intake, let a doctor know. They can recommend options that will help you meet your goal, and these can be part of your treatment plan.
• Eating a healthy diet: A healthy diet that’s low in saturated fats and high in plants, whole grains, seafood, and other healthy staples can help reduce fat around your liver.
• Controlling your blood sugar: Blood sugar spikes, especially spikes from foods high in sugars, can damage your liver. This is true even if you don’t have diabetes. That’s why it’s important to stick to whole grains and other high-nutrient foods.
• Getting exercise: Exercise can help you manage weight and stress, resulting in a healthier liver. There are lots of ways to start exercising.
• Keeping up a moderate weight: Keeping up a moderate weight can keep down the fat levels around your liver and liver inflammation. Fat around your liver goes down when you lose between 3% and 5% of your body weight, and inflammation goes down when you lose between 5% and 10% of your body weight. A doctor can help you create a plan to keep up a moderate weight.

Cost and coverage of steatohepatitis treatments

Treatment plans for steatohepatitis are largely based on lifestyle changes. There aren’t high costs associated with most treatment options. But you might be able to use your Medicare or other insurance benefits to help you achieve those lifestyle changes.

For instance, many insurance plans, including many Medicare Advantage plans, offer free or low-cost fitness options to members. You might be able to join local gyms, take classes, download fitness apps, and more. This can be a great way to help reduce the fat around your liver.

Can steatohepatitis be reversed?

Lifestyle changes can reduce and even eliminate both inflammation and fat around your liver. This can reverse steatohepatitis.

If inflammation progresses enough to cause scarring, the scar tissue will remain even when the inflammation is gone. This can’t be reversed. But as long as the scarring isn’t covering large areas of your liver, you can still make a full recovery. You’ll still have enough healthy liver tissue left for full organ function, and you won’t experience any further symptoms.

If steatohepatitis isn’t managed through lifestyle changes, it will cause permanent liver scarring. This can lead to serious liver damage. Over time, liver damage can result in liver failure, a condition that’s fatal without an organ transplant.

It’s important to keep in mind that you’ll need to keep up all lifestyle changes. Even if a doctor tells you your liver looks completely healthy again, it’s best to keep up a moderate weight, stick with your diet, and avoid alcohol.

Without sticking to these lifestyle changes, you’ll be at risk of fatty liver and steatohepatitis returning.

Steatohepatitis is the stage of fatty liver disease when symptoms begin to show. It occurs when your liver swells. Steatohepatitis is often associated with chronic long-term alcohol use, but it can also develop in people who rarely or never drink alcohol.

Both alcoholic and nonalcoholic steatohepatitis can lead to liver scarring. Without treatment, liver scarring can permanently damage your liver.

Treatment for steatohepatitis is lifestyle based and includes reducing or stopping alcohol consumption, keeping up a moderate weight, and following a healthy diet. Treatment can eliminate inflammation and resolve steatohepatitis.