Comparative studies on cryptogenic chronic liver disease specially related to non-alcoholic steatohepatitis (nash) verses other known causes of liver diseases with features of de-compensation - A case control study

Context: The prevalence of cryptogenic cirrhosis ranges from 5% to30% of cirrhotic patients in past series. Several explanations may be offered as possible underlying etiologies include occult alcohol abuse, occult viral (non-B, non-C hepatitis, silent autoimmune hepatitis, or progression of nonalcoholic steatohepatitis (NASH). Aims: To compare the clinical, biochemical and histologic features between the advanced cryptogenic chronic liver disease and decompensated chronic liver disease with known etiology. Setting and Design: Hospital based retro-spective study Materials and Methods: This study was conducted in the Department of Gastroenterological Sciences, CMC, Ludhiana. There were a total of 100 subjects, (50 subjects were cases and 50 were controls). The reports of liver biopsies were examined. All sequential cases of those with histological evidence of Steatohepatitis were chosen and their records examined. This group formed the cases for the study. From the records of the same years a further 50 patients were chosen arbitrarily if they had a known cause of the disease, so a definite disease aetiology the basis of choosing the second 50 (i.e. controls). Results: In the current study, we found that controls were more likely to have Jaundice, ascites and gastrointestinal bleeding. The cases were more likely to have pedal edema and low albumin that indicates more pronounced parenchymal injury associated in this group. These differences were statistically significant (p<0.005). Conclusion: This comparative study is well co related with decompansated chronic liver disease between the crypto group and known causes of liver disease. In an end stage of both the conditions due to loss of bio-synthetic, and other metabolic function of liver, one can not differentiate these two condition by histologic or calculating MELD , so early stage of liver biopsy is mandate for crypto groups to look for any features of NASH.