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2018, Número 2

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Rev Hosp Jua Mex 2018; 85 (2)


La enfermedad por hígado graso no alcohólico y el trabajo del internista

Delgado-Cortés HM, García-Juárez FI, García-Juárez I

Idioma: Español
Referencias bibliográficas: 44
Paginas: 86-93
Archivo PDF: 223.98 Kb.


RESUMEN

La enfermedad por hígado graso no alcohólico es el reflejo de una enfermedad sistémica y actualmente es reconocida como el componente hepático del síndrome metabólico. La prevalencia en nuestro medio no está bien definida, pero se ha reportado una prevalencia mundial de 25.24% y en aumento paralelo a la epidemia de obesidad. Esta entidad incluye la esteatohepatitis no alcohólica, una forma progresiva de la enfermedad, la cual está asociada a cirrosis y complicaciones cardiovasculares. El cuadro clínico es inespecífico, normalmente los pacientes son diagnosticados en un estudio de imagen indicado por otro motivo o referidos por presencia de alteraciones en transaminasas. La resistencia a la insulina desempeña un papel central en la fisiopatología y se han descrito mecanismos añadidos como componentes genéticos, la raza (hispanoamericanos), la dieta, el estrés oxidativo y la disbiosis intestinal. Existen métodos no invasivos como escalas y métodos de imagen para estimar la esteatosis y el grado de fibrosis hepática, aunque el diagnóstico de la esteatohepatitis no alcohólica sigue siendo mediante biopsia hepática. Las opciones terapéuticas en la actualidad son limitadas, las modificaciones al estilo de vida con dieta y ejercicio continúan siendo el pilar del tratamiento. Fármacos como la pioglitazona y la vitamina E tienen poca efectividad, pero nuevos fármacos continúan en desarrollo. El médico internista debe estar familiarizado con la enfermedad, establecer el riesgo de complicaciones locales (fibrosis, cirrosis, hepatocarcinoma) o sistémicas (cardiovasculares), establecer un plan de tratamiento integral y en caso necesario referir en forma temprana al gastroenterólogo.


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