Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

• Main Authors: Vajro Pietro, Lenta Selvaggia, Pignata Claudio, Salerno Mariacarolina, D’Aniello Roberta, De Micco Ida, Paolella Giulia, Parenti Giancarlo
• Format: Article
• Language: English
• Published: BMC 2012-10-01
• Series: Italian Journal of Pediatrics
• Subjects: Non alcoholic fatty liver disease; Children; Therapy
• Online Access: http://www.ijponline.net/content/38/1/55
• ISSN: 1720-8424; 1824-7288

<p>Abstract</p> <p>The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD), a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants) and on innovative therapeutic options as well.</p> <p>Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study) showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.</p>