Hígado graso (parte 1): aspectos generales, epidemiología, fisiopatología e historia natural

Autores/as

DOI:

https://doi.org/10.22516/25007440.952

Palabras clave:

Hígado graso, fisiopatología, Historia Natural

Resumen

El hígado graso no alcohólico (NAFLD) se define por la presencia de grasa o esteatosis en los hepatocitos y abarca un espectro que va desde la esteatosis simple, pasa por la esteatohepatitis no alcohólica (NASH) con inflamación y fibrosis, y finaliza en la cirrosis. Se considera una prevalencia mundial global cercana al 25% en la población general y se diagnóstica entre los 40 y 50 años, con variaciones respecto al sexo predominante y con diferencias étnicas (la población hispana es la más afectada). El hígado graso está asociado al síndrome metabólico (SM), y la obesidad se considera el principal factor de riesgo con su presencia y con su progresión.

El hígado graso es un trastorno complejo y muy heterogéneo en su fisiopatología, que resulta de la interacción de múltiples elementos: factores genéticos, epigenéticos, ambientales, culturales, entre otros. Todo ello en conjunto lleva a incremento paulatino de grasa hepática, resistencia a la insulina y alteraciones hormonales y de la microbiota intestinal, lo que genera un daño hepatocelular a través de la formación de radicales libres de oxígeno y activación de la fibrogénesis hepática.

La historia natural del hígado graso es dinámica: los pacientes con esteatosis simple tienen bajo riesgo de progresión a cirrosis, mientras que en los pacientes con NASH este riesgo se aumenta; sin embargo, el proceso puede ser reversible y algunas personas tendrán una mejoría espontánea. La fibrosis parece ser el determinante de la mortalidad global y de los desenlaces asociados a la enfermedad hepática; se considera que en todos los pacientes la fibrosis empeora una etapa cada 14 años y en NASH empeora en una etapa cada 7 años. Estudios previos concluyen que aproximadamente 20% de los casos de esteatosis simple progresan a NASH y que, de ellos, aproximadamente el 20% progresan a cirrosis, con presencia de hepatocarcinoma (HCC) en el 5% a 10% de ellos.

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Biografía del autor/a

Jhon Edison Prieto-Ortiz, Centro de enfermedades hepáticas y digestivas (CEHYD)

Médico especialista en Medicina interna, Gastroenterología y Hepatología, Universidad Nacional de Colombia, Hospital Clínic de Barcelona, Centro de enfermedades hepáticas y digestivas (CEHYD). Bogotá, Colombia. 

 

Carlos Bernardo Sánchez Luque, Centro de Enfermedades Hepáticas y Digestivas CEHYD.

Médico Especialista en Gastroenterología y Endoscopia Digestiva. Hepatología. Clínica Colsanitas Keralty. Hospital Universitario Fundación Santafé. Bogotá, Colombia.

Rolando Ortega Quiróz MD. MSc. FAASLD, Clínica del Norte

Médico especialista en Medicina interna, Gastroenterología y Hepatología, Universidad de Cartagena, Universidad Nacional de Colombia, Hospital Clínic de Barcelona. Jefe servicio de gastroenterología y Hepatología clínica del Norte, Barranquilla, Colombia.

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Figura 1. Fisiopatología del hígado graso. Fuente: elaboración propia

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2022-12-21

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Prieto Ortíz, J. E., Sánchez Luque, C. B., & Ortega Quiróz, R. J. (2022). Hígado graso (parte 1): aspectos generales, epidemiología, fisiopatología e historia natural. Revista Colombiana De Gastroenterología, 37(4), 420–433. https://doi.org/10.22516/25007440.952

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