Health & Medical stomach,intestine & Digestive disease

State of the Art: Treatment of Nonalcoholic Steatohepatitis

State of the Art: Treatment of Nonalcoholic Steatohepatitis

Colesevelam


Colesevelam is a bile acid sequestrant that reduces low-density lipoprotein cholesterol by interfering with enterohepatic circulation of bile acids, as well as improving glucose homeostasis by upregulating glucagon-like peptide-1. The effect of colesevelam on liver fat content after 24 weeks of treatment was evaluated by MRI-determined proton density fat fraction (MRI-PDFF) in patients with biopsy-proven NASH. Contrary to the proposed hypothesis, the intervention group had a significant increase in liver fat content based on MRI-PDFF compared with placebo (P = 0.01); however, there was no significant increase in steatosis grade based on postintervention liver biopsy (P = 0.1). The discordance between imaging and liver biopsy may be explained by sampling variability and difficulty in detecting small amount of changes in liver fat content via biopsy, suggesting that MRI-PDFF is better than liver biopsy for the assessment of quantitative changes in liver fat.

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