Elsevier

The Journal of Pediatrics

Volume 127, Issue 5, November 1995, Pages 700-704
The Journal of Pediatrics

Idiopathic steatohepatitis in childhood: A multicenter retrospective study,☆☆,

https://doi.org/10.1016/S0022-3476(95)70156-7Get rights and content

Abstract

Objective: To describe the clinical, laboratory, and histopathologic features of idiopathic steatohepatitis in children. Study design: Retrospective review of all liver biopsies performed at Boston Children's Hospital, Massachusetts General Hospital, and the University of Massachusetts Medical Center from 1991 to 1994. Chart review was performed when biopsies demonstrated steatosis. Results: Eighty-two patients had biopsy-proven hepatic steatosis. Fourteen patients had fatty liver without evidence of inherited, infectious, autoimmune, endocrinologic, toxicologic, or iatrogenic causes. All 14 patients were obese, averaging 159% of ideal body weight (range, 121% to 222%). Nine patients initially had transient abdominal pain, two had hepatomegaly, and one was identified by incidental laboratory evaluation. These 12 patients had biopsies because of persistent elevations of aminotransferase levels. Two other patients without risk factors for steatosis were identified at staging laparotomy for Hodgkin lymphoma. The 10 boys and 4 girls had an average age of 13.5 years (range, 10 to 18 years). Aminotransferase elevations were modest, with aspartate aminotransferase and alanine aminotransferase values averaging 77 ± 38 IU and 129 ± 73 IU, respectively. All had imaging studies demonstrating diffuse fatty change. Histologic examination of biopsy specimens revealed varying degrees of steatosis with inflammation and fibrosis. Conclusion: Idiopathic steatohepatitis occurs predominantly or exclusively in obese peripubertal children. This entity represents a frequent reason for liver biopsy in this age group. The degree of steatosis, fibrosis, and inflammation does not correlate with symptoms or signs, and significant liver injury with bridging fibrosis may be present. (J PEDIATR 1995;127:700-4)

Section snippets

Patient selection

We reviewed 650 liver biopsies performed on children (from birth to 18 years of age) between January 1, 1991, and December 31, 1994, at Children's Hospital, Boston, Massachusetts General Hospital, and the University of Massachusetts Medical Center. Eighty-two patients with light microscopic evidence of microvesicular or macrovesicular steatosis were identified. Any patient with evidence of a metabolic, infectious, autoimmune, endocrinologic, toxicologic, or iatrogenic cause of hepatosteatosis

Clinical data

The patients, 10 boys and 4 girls, ranged in age from 10 to 18 years, with an average age of 13.5 years. All were obese, averaging 159% IBW (range, 120% to 222% IBW). The mean height was 106% ± 19% (±1 SD). Biopsies were performed for the evaluation of persistently elevated serum aminotransferase values (>6 months) or as staging procedures in two patients with Hodgkin lymphoma. Of the patients with elevated aminotransferase values, six had abdominal pain associated with acute illness, four had

DISCUSSION

Previous reports have demonstrated steatohepatitis or suspected steatohepatitis in obese children.9, 10, 11, 12 In a recent abstract of a retrospective study of biopsies from patients with idiopathic steatohepatitis at the Hospital for Sick Children, investigators found 26 nondiabetic patients during a 10-year interval, of whom 25 were obese. The average age, male/female ratio, and laboratory values were similar to ours.9 Kinugasa et al.11 demonstrated elevated aminotransferase values in 16.2%

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From the Center for Childhood Liver Disease, Combined Program in Pediatric Gastroenterology, the Department of Pathology, Children's Hospital, and the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

☆☆

Reprint requests: Joel E. Lavine, MD, PhD, Joint Program in Pediatric Gastroenterology, University of California San Diego Medical Center, 200 W. Arbor Dr., San Diego, CA 92103-8450.

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