Nonalcoholic steatohepatitis (NASH) is a serious liver condition that affects millions of people worldwide. NASH is a type of liver disease that falls under the umbrella of nonalcoholic fatty liver disease (NAFLD). NASH occurs when fat buildup leads to inflammation and cell damage in the liver.1,2
NASH is more serious than simple fatty liver. If left untreated, it can lead to complications like cirrhosis, liver failure, and liver cancer. Understanding the signs and symptoms of NASH is crucial for early detection and management. If the conditions are caught early enough, certain lifestyle changes can stop the progression of NAFLD and NASH.1,3
NASH is a “silent disease”
NASH is often referred to as a “silent disease” because it progresses without noticeable symptoms in its early stages. Unlike some other health conditions that have obvious signs and symptoms, NASH advances quietly. It causes damage to the liver without the person being aware that anything is wrong.2,3
This lack of symptoms can lead to delayed diagnosis and treatment, allowing the disease to advance to stages when symptoms finally become apparent. This is why knowing the NASH risk factors and getting routine screenings are essential for detecting it early and preventing complications.1,3
What are the signs and symptoms of NASH?
Signs and symptoms of NASH can vary from person to person. Many people with NASH will have no symptoms until they have progressed to the advanced stage of cirrhosis. If you have any of the following symptoms or any of the risk factors for NASH, contact your doctor to have your liver health evaluated.1,3
Early stages
In the early stages of NASH, people may not have any noticeable symptoms. However, some early signs may include:1,2
- Fatigue – Feeling unusually tired or weak, even after getting enough rest.
- Discomfort in the stomach area – A dull ache or heaviness in the upper right side of the abdomen, where the liver is located.
- Elevated liver enzymes – Elevated liver enzymes can be a sign of liver inflammation and damage. They can be detected by specific blood tests that look at how your liver is functioning.
Advanced stages
As NASH progresses, the liver is not able to function as it should. This leads to a variety of symptoms that become stronger with time, including:1-3
- Persistent fatigue
- Abdominal pain
- Abdominal swelling
- Swelling in the legs (edema)
- Itchy skin
- Shortness of breath
- Yellowing of the skin and eyes (jaundice)
- Red palms
- Spider-like blood vessels under the skin
Once NASH has advanced so much that there is permanent scarring of the liver – known as cirrhosis – a person’s health dramatically starts to decline. If cirrhosis is left untreated, the following symptoms can occur:1,3
- Fluid buildup, mostly in the stomach area
- Muscle loss, also called “muscle wasting”
- Enlarged spleen
- Swollen veins that can rupture and cause internal bleeding
- Confusion or impaired thinking
- End-stage liver failure
- Liver cancer
When to see a doctor
If you experience any of the above symptoms or have risk factors for liver disease, contact your doctor. They can evaluate the health of your liver, check your overall health, and advise you on appropriate next steps.1,3