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Nichtalkoholische Fettlebererkrankungen

Nonalcoholic fatty liver diseases

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Zusammenfassung

Das Spektrum nichtalkoholischer Fettlebererkrankungen (NAFLD) umfasst die Steatose, Steatohepatitis, Steatofibrose und Zirrhose und in manchen Fällen das hepatozelluläre Karzinom. NAFLD sind als hepatische Komponente des metabolischen Syndroms die häufigsten Lebererkrankungen in westlichen Ländern und die häufigste Ursache für Aminotransferasenerhöhungen unklarer Genese. Von zentraler pathogenetischer Bedeutung sind das viszeroabdominale Fettgewebe und die Insulinresistenz. Die Behandlung entspricht in den meisten Fällen der Behandlung des metabolischen Syndroms. Die Verbesserung der Insulinsensitivität durch Metformin oder Thiazolidindione ist ein vielversprechender, pathogenetisch begründeter Therapieansatz. Der generelle Einsatz dieser Pharmaka bei Patienten mit NAFLD ohne Diabetes mellitus ist allerdings nach derzeitiger Datenlage nicht gerechtfertigt. Magen-Bypassoperationen bei Adipositas permagna führen zur Gewichtsabnahme und oft auch zur Normalisierung der bei NAFLD pathophysiologisch bedeutsamen metabolischen Veränderungen.

Abstract

Nonalcoholic fatty liver diseases (NAFLD) encompass a spectrum of hepatic changes ranging from steatosis to steatohepatitis, steatofibrosis and cirrhosis and in some cases to hepatocellular carcinoma. NAFLD is the most common liver disease in industrialized countries and the most common cause of elevated aminotransferases of unknown origin. NAFLD is regarded as the hepatic component of the metabolic syndrome and central to its pathogenesis is the degree of visceral obesity and insulin resistance. The management of NAFLD in most cases is the management of the metabolic syndrome. Enhancing insulin sensitivity with metformin or thiazolidinediones is a promising approach, however, the clinical data are still preliminary and at present the general use of these drugs in patients with NAFLD without diabetes mellitus is not recommended. Weight loss induced by gastric bypass surgery may normalize the metabolic abnormalities involved in the pathogenesis of NAFLD.

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Dancygier, H. Nichtalkoholische Fettlebererkrankungen. Gastroenterologe 1, 221–230 (2006). https://doi.org/10.1007/s11377-006-0032-y

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