Steatohepatitis is steatosis plus inflammation and damage to liver cells (ballooning degeneration of hepatocytes). Unlike "pure" fatty liver, here there is an active process that can lead to fibrosis and cirrhosis.
Two main variants are distinguished: non-alcoholic (NASH, now MASH) and alcoholic — part of alcoholic liver disease. Under the microscope they look alike; the difference is in the cause.
How the diagnosis is made
The "gold standard" is a liver biopsy: a diagnosis of steatohepatitis requires steatosis, lobular inflammation and ballooning degeneration of hepatocytes all at once. Activity is graded on the NAS scale.
In practice, non-invasive signs are used first: a rise in ALT and AST (cytolysis), calculated fibrosis indices and elastography.
Alcoholic and non-alcoholic
Histologically, alcoholic and non-alcoholic steatohepatitis are hard to tell apart — the history is decisive. An AST/ALT ratio above 2 and an elevated GGT argue for the alcoholic variant.
Non-alcoholic steatohepatitis develops against a background of metabolic disorders (obesity, diabetes), not alcohol.
Treatment
The main thing is to remove the cause: complete abstinence from alcohol in the alcoholic form, and weight loss and metabolic control in the non-alcoholic form. For non-alcoholic steatohepatitis with fibrosis, drugs have appeared (for example, resmetirom for stages F2–F3).
Reference ranges
The activity of steatohepatitis on the NAS (NAFLD Activity Score) — the sum of three histological features in a biopsy.
| Steatosis | 0–3 points |
| Ballooning degeneration | 0–2 points |
| Lobular inflammation | 0–3 points |
| Diagnosis of steatohepatitis | usually NAS ≥ 5 when all three features are present |
Calculate using this marker
Calculators where Steatohepatitis is used directly:
Frequently asked questions
How does steatohepatitis differ from steatosis?
In steatosis the liver has simply accumulated fat. In steatohepatitis, inflammation and damage (ballooning degeneration) of the cells are added to the fat — and that is exactly what leads to fibrosis and cirrhosis.
Is steatohepatitis reversible?
The inflammation can be quenched, and early fibrosis is partly reversible if the cause (alcohol, excess weight) is removed. Advanced fibrosis and cirrhosis are already irreversible.
Related terms
Sources
- AASLD Liver Fellow Network — Liver Pathology: Steatohepatitis
- StatPearls (NCBI) — Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
- American Liver Foundation — Nonalcoholic Steatohepatitis (NASH)