OBJECTIVES

: Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease. This chronic liver disease currently affects 1.5-6.45% of the global population and its incidence and prevalence are increasing. Limited research has qualitatively explored the impact of NASH on patients’ health-related quality of life (HRQL). This study aimed to explore the symptomatic and HRQL burden of NASH at different fibrosis stages using qualitative methods.

METHODS

: Semi-structured interviews were conducted with NASH patients from the UK and USA with biopsy/fibroscan confirmed fibrosis stage. Recruitment aimed to cover the range of fibrosis stages (F0: no fibrosis to F4: cirrhosis). The study received ethics approval and all participants provided consent. Interviews followed a semi-structured interview guide and explored symptoms and HRQL impacts. Qualitative data were analysed using thematic analysis and background data were summarised descriptively.

RESULTS

: The participants (n=17; mean age = 46; 71% female and 94% ≥1 comorbidity) self-reported their fibrosis stage: F0 (6%); F1 (12%); F2 (29%); F3 (29%); F4 cirrhosis (24%: 18% compensated and 6% decompensated). Participants reported significant symptomatic and HRQL burden at all fibrosis stages. Fatigue/tiredness (N=17) and abdominal pain (N=16) were common symptoms and more severe at advanced stages (F3 and F4). Cognitive problems, sleep issues and nausea/vomiting/bloating were also common (N=10-15). Itchy skin, sweating, bowel issues and weight gain were relevant but reported less frequently. Participants reported an impact on daily, social and physical activities, emotional well-being, relationships, work and diet. Impacts on emotions, daily activities, physical activities, self-care and relationships were more severe at advanced stages (F3 and F4).

CONCLUSIONS

: This study highlights the substantial symptomatic and HRQL burden experienced by NASH patients. The HRQL burden was most severe in patients with more advanced fibrosis. However patients in the earlier stages (F0-3) also reported significant burden.