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It is not clear whether the accumulation of fat in the liver is responsible for the subsequent inflammation or whether inflammation induced by some stimulus causes hepatocyte dysfunction to result in steatosis. Steatosis is not always edema associated with inflammation and fibrosis, edema and fatty liver may be a secondary phenomenon in the pathogenesis of NASH rather than a primary initiating factor;24 however, some studies tend to demonstrate a correlation between the degree of edema steatosis and the degree of fibrosis.25 Treatment Strategies: There is no established therapy for NASH, however empiric treatment strategies have been proposed (see Table 2). Table 2 Treatment Strategies Dieting Weight Reduction ·Gradual ·Moderate ·Not Complete Antibiotics Metronidazole (for jejunoileal bypass) Surgery ·Gastroplasty ·Gastric Bypass Drug with Lipid-altering Properties and Direct Cytoprotective Effects: ·Ursodeoxycholic Acid Trial Dieting Weight reduction can improve laboratory abnormalities, histologic changes and liver size,26 however, improvements can be achieved even if the patient
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