Estimated reading time: 6 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Metabolic dysfunction-associated steatohepatitis (MASH) is a serious liver condition that, if left untreated or poorly managed, can lead to severe complications like liver cirrhosis, liver cancer, and the need for a liver transplant. But how does it get to that stage? What can you do, if you have MASH, to prevent it from getting that far? Fortunately, there are some steps you can take and management strategies you can adopt that lower your risk of progression. Here, PatientsLikeMe will explain how MASH progresses into these advanced stages and what patients can do to manage their health.
What is MASH?
MASH, or metabolic dysfunction-associated steatohepatitis, is an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD happens when fat builds up in the liver, often without causing noticeable symptoms. Most people, in fact, don't know they have MASLD because it often does not cause any symptoms when it first develops! Up to 33.6% of adults in the US may have MASLD. Of those with MASLD approximately 20-30% develop inflammation and liver damage leading to MASH. Despite its similarity to alcohol-related liver diseases, MASH can happen in people who consume little or no alcohol. Instead, it is often linked to conditions like obesity, diabetes, and metabolic syndrome.
From MASH to Liver Cirrhosis
One of the most serious complications of MASH is liver cirrhosis, which effects 5% to 12% of people with the condition. Cirrhosis happens when chronic inflammation from MASH leads to scarring (fibrosis) of the liver tissue. Over time, this scar tissue replaces healthy liver cells. This reduces the liver’s ability to function properly.
What is Liver Cirrhosis?
Cirrhosis is often called end-stage liver disease because it represents the final phase of chronic liver damage. The liver plays a few key roles in the body. It detoxifies the blood, stores nutrients, and helps with digestion. Once it has been damaged enough by cirrhosis, its ability to do these tasks becomes impaired. This can lead to symptoms like:
- Ascietes, or fluid buildup in the belly
- Jaundice, or the yellowing of the skin and eyes
- Easy bruising and bleeding
- Fatigue and weakness
- Confusion because of toxins in the blood
Cirrhosis also leads to complications like portal hypertension, which increases blood pressure in the portal vein and can cause dangerous bleeding in the esophagus or stomach. If untreated, it can eventually lead to kidney failure.
Can Cirrhosis Be Treated?
While the damage caused by cirrhosis is permanent, treatments can slow its progression. Lifestyle changes, medications, and managing underlying conditions like diabetes or obesity can help prevent further liver damage. Regular screenings for liver cancer are also important for people with cirrhosis.
The Link Between Cirrhosis and Liver Cancer
Liver cirrhosis significantly increases the risk of liver cancer. Chronic liver inflammation and repeated cycles of damage and repair can cause DNA mutations in liver cells, leading to cancer. In fact, 80-90% of liver cancer cases happen in people with cirrhosis. However, having cirrhosis does not mean you will definitely develop cancer.
Symptoms of Liver Cancer
Early symptoms of liver cancer can be hard to detect. They include:
- Unexplained weight loss
- Loss of appetite
- Feeling full after eating small amounts
- Persistent nausea or fatigue
- Pain in the abdomen
- Enlarged liver or spleen
Regular imaging tests, such as ultrasounds, and blood tests can help detect liver cancer in its early stages when it is more treatable. Treatment options depend on the stage of cancer and may include surgery, targeted therapies, or, in some cases, a liver transplant.
When is a Liver Transplant Needed?
A liver transplant is necessary when the liver can no longer function because of severe cirrhosis or liver cancer. Transplants are considered when other treatments fail to manage symptoms or complications. To qualify for a liver transplant, patients typically go through an evaluation to determine their eligibility. Key factors include:
- The severity of liver disease, often measured by the Model for End-Stage Liver Disease (MELD) score.
- Overall health and ability to undergo surgery.
- The absence of other serious health conditions that could complicate recovery.
The Transplant Process
The transplant process involves several steps. First, you need an evaluation. A medical team will look at your health, disease stage, and suitability for surgery. After determining your eligibility, you will be placed on a national waiting list. The priority for this list is based on the severity of your condition and the likelihood of a successful outcome. Finally, if you are chosen for the transplant, you will undergo surgery to replace the diseased liver with a healthy donor. Even after the surgery however, you will require lifelong monitoring and medications to make sure your body does not reject the donor organ. This happens in about 30% of all liver transplant cases and is because your body's immune system starts to attack the transplanted liver.
Patients with MASH who undergo liver transplants generally have good long-term outcomes, although there is a risk of MASH recurring in the new liver. Keeping a healthy lifestyle and managing conditions like diabetes or obesity can help improve the success of a transplant.
Taking Action to Prevent Progression
Early detection and treatment of MASH are key to preventing its progression to cirrhosis, liver cancer, or the need for a liver transplant. May sure you follow these tips!
- Regular Check-Ups: Get routine blood tests and imaging done to help monitor liver health.
- Lifestyle Changes: Adopt a healthy diet, exercise regularly, and manage weight to reduce fat in the liver.
- Managing Underlying Conditions: Control conditions like diabetes, high cholesterol, and metabolic syndrome to improve outcomes.
- Avoiding Alcohol: Even moderate alcohol consumption can worsen liver damage in people with MASH. Try to avoid it!
MASH is a serious but manageable condition. By understanding how it progresses to cirrhosis, liver cancer, and the need for a transplant, patients and caregivers can take proactive steps to protect liver health. Early intervention and lifestyle changes play a critical role in slowing disease progression and improving quality of life.
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