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Nonalcoholic Steatohepatitis: A Proposal for Grading and Staging The Histological Lesions
Abstract
Objective Steatohepatitis is a morphological pattern of liver injury that may be seen in alcoholic or nonalcoholic liver disease. This pattern may occur with obesity, diabetes, the use of certain drugs, or the cause may be idiopathic. The well-recognized histopathological features of nonalcoholic steatohepatitis (NASH) include hepatocellular steatosis and ballooning, mixed acute and chronic lobular inflammation, and zone 3 perisinusoidal fibrosis. Currently, there are no systems for grading necroinflammatory activity or for staging fibrosis as exist for various other forms of chronic liver disease. The purpose of this study was to develop such a grading and staging system and was based on review of liver biopsies from 51 patients with nonalcoholic steatohepatitis from Saint Louis University Health Sciences Center. Methods For determination of grade, 10 histological variables of activity were initially analyzed; an overall impression of mild, moderate, and severe was made and the variables considered to be most significant were used to develop the necroinflammatory grade. Results The histological lesions considered to be significant were: steatosis, ballooning, and intra-acinar and portal inflammation. A staging score was developed to reflect both location and extent of fibrosis. The fibrosis score was derived from the extent of zone 3 perisinusoidal fibrosis with possible additional portal/periportal fibrosis and architectural remodeling. Fibrosis stages are as follows: Stage…
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“To evaluate the severity of MASH, MASLD activity score (NAS) was scored according to predefined criteria.”
From SGLT2 inhibitor promotes ketogenesis to improve MASH by suppressing CD8+ T cell activation (2024) · cites this paper as [47]
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Metadata
- Authors
- Brunt, E. M., Janney, C. G., Di Bisceglie, A. M., Neuschwander-Tetri, B. A., & Bacon, B. R.
- Affiliations
- Saint Louis University (US)
- Corresponding author
- Brunt, Elizabeth M
- ORCID
- Brunt, Elizabeth M
- Venue
- American Journal of Gastroenterology
- Published
- 1999-09
- Volume
- 94
- Issue
- 9
- Pages
- 2467-2474
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W2087829753
- Cited by
- 3,907
- References
- 0
- Citations by year
- 2026: 84 · 2025: 108 · 2024: 150 · 2023: 157 · 2022: 166 · 2021: 188 · 2020: 203 · 2019: 169 · 2018: 170 · 2017: 195 · 2016: 184 · 2015: 175 · 2014: 203 · 2013: 185 · 2012: 189
- FWCI
- 17.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- nonalcoholic steatohepatitis, histological grading, fibrosis staging, necroinflammatory activity, ballooning, lobular inflammation, perisinusoidal fibrosis, portal fibrosis, bridging fibrosis, liver cirrhosis, liver biopsy
- MeSH terms
- Biopsy, Fatty Liver, Hepatitis, Humans, Retrospective Studies, Severity of Illness Index
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