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Gastroenterologie up2date 2010; 6(3): 173-188
DOI: 10.1055/s-0030-1255706
Leber/Galle/Pankreas

© Georg Thieme Verlag KG Stuttgart · New York

Nicht alkoholische Steatohepatitis (NASH) – Ursachen, Diagnostik und Therapie

Konrad  L.  Streetz, Frank  Tacke
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Publication History

Publication Date:
30 August 2010 (online)

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Kernaussagen

Definition und Pathogenese

  • Die Fettleber (NAFLD, non alcoholic fatty liver disease) ist definiert als eine Ansammlung von intrahepatischem Fett, die 5 % des Gesamtgewichts der Leber übersteigt. Die NASH (nicht alkoholische Steatohepatitis) wird über das Auftreten einer zusätzlichen entzündlichen Komponente definiert.

  • Fettlebererkrankungen stellen die häufigste Form einer Hepatopathie in unserer Gesellschaft dar. Als Risikofaktoren gelten Übergewicht, Hypertonus, Hyperlipidämien und der Diabetes mellitus.

  • Die Erkrankung zeigt einen Progress von der reinen Fettleber über die Fettleberhepatitis (NASH) bis hin zur Zirrhose mit möglicher Karzinomentwicklung.

Diagnostik und Therapie

  • Zur Diagnosestellung einer NASH wird der histologische Nachweis charakteristischer Veränderungen, der Ausschluss eines relevanten Alkoholkonsums und einer viralen Hepatitis gefordert.

  • Die therapeutischen Alternativen zur Behandlung der Fettleber und assoziierter Erkrankungen sind vielfältig, führen jedoch ob der Komplexität des Krankheitsbildes zu sehr variablen und selten dauerhaften Therapieerfolgen.

  • Wichtige Maßnahmen sind Gewichtsreduktion, verbunden mit einer Änderung der Lebensgewohnheiten, und ein regelmäßiges aerobes Ausdauertraining. Vielversprechende medikamentöse Therapieansätze sind derzeit Pioglitazon und Vitamin E.

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PD Dr. med. Konrad Streetz

Medizinische Klinik III
Universitätsklinikum Aachen

Pauwelsstraße 30
52074 Aachen

Email: Kstreetz@ukaachen.de

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