‘Stat rosa pristina nomine, nomina nuda tenemus’ (“The rose exists well before its name; names are only a pale representation of the real nature of things”) ‘The Name of the Rose’ by Umberto Eco.Evolution of language is as old as language itself and the ever-changing terminology in the medical sciences remains an immediate challenge for all of us except perhaps the very newest trainees who will soon find their own common terms to have all too soon transitioned to anachronisms. Such evolution in language is indeed relevant to the diagnosis of non-alcoholic steatohepatitis-related cirrhosis (‘NASH cirrhosis’) and ‘cryptogenic cirrhosis’. The recognition that NASH cirrhosis progresses to an advanced state characterized by loss of a vital histological hallmark ‘steatosis’, and thus to loss of an even more foundational biopsy finding of ‘steatohepatitis’ was a conceptual sea-change.
[1]
Early epidemiological studies indicated that this process was characteristic of the
transition of NASH cirrhosis to cryptogenic cirrhosis.
2
,
3
,
4
Indeed, the progression of NASH is now known to be associated with loss of fat (perhaps
through changes in blood flow and insulin exposure) and diminished serum aminotransferases,
albeit with increasing fibrosis.
[5]
In the absence of a prior diagnosis of NASH or at least non-alcoholic fatty liver
disease (NAFLD), liver histology at this stage appears as cirrhosis of unknown cause
or ‘cryptogenic cirrhosis’.
[6]
Following a transition period from around 2000 to 2014, the term ‘cryptogenic’ cirrhosis
has come to be commonly equated to ‘NASH cirrhosis’. This may well be the most likely
situation in the majority of cases, however, the authors of the present study raise
a wise cautionary flag regarding the need to consider other possibilities.To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 13, 2017
Accepted:
December 5,
2017
Received:
December 5,
2017
See Article, pages 519–525Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
