It is the “disease of the century” and it is progressing in the shadows: MASH has already struck a million French people, transforming their liver into a time bomb without the slightest symptom.
If the liver is often the forgotten one in our health, the explosion of this new pathology of the century brutally reminds us that it is the first silent victim of our modern lifestyles. Having remained in the shadows for a long time, MASH is an inflammatory form of “fatty liver” disease. Now at the heart of medical concerns, this pathology (formerly called NASH for Non-Alcoholic Steatohepatitis), it changed its name to MASH in order to emphasize the true cause of the disease – a metabolic dysfunction – while removing the term “non-alcoholic”, considered stigmatizing for patients. “We no longer define the patient by what he does not drink, but by a clear health problem (metabolism). It is much more dignified and medically fairer“, explains Professor Laurent Castera, hepatologist at Beaujon hospital in Paris. In France, 8 million French people have an overly fatty liver (simple steatosis), 1 million of whom have taken the step towards MASH. The major risk is that MASH develops into cirrhosis or liver cancer.
Today, diagnosis has been considerably simplified and humanized. “We have abandoned the liver biopsy, an invasive and dreaded examination, in favor of non-invasive methods. We now perform simple blood tests (like the FIB-4 score) that assess the health of your liver at a glance. If any doubt remains, we use FibroScan (a kind of ultrasound which measures the elasticity of the liver) or new, very efficient metabolic MRI techniques.“, explains Professor Laurent Castera. These tools make it possible to detect liver scars with surgical precision, without even having to prick the organ.
The biggest pitfall of MASH is its asymptomatic nature for many years. It is also said that it is a “silent disease”. However, certain weak signals can alert you, especially if they persist for a long time: unexplained and persistent fatigue is often the first sign reported by patients. Some people also describe a feeling of heaviness or dull discomfort in the upper right part of the abdomen (under the ribs).
At a more advanced stage, itchy skin, slight yellowing of the whites of the eyes or swelling of the ankles may appear. “If you suffer from type 2 diabetes, high blood pressure or are overweight, don’t wait for symptoms to see a doctor. Likewise, if you have a regular consumption of alcohol, even moderate, vigilance is required because it can accelerate liver damage.“, continues the expert.
For a long time, weight loss and regular physical activity were doctors’ only recourses to combat MASH. SWhile these pillars remain essential today, they are now supplemented by a new generation of drugs. “There are mainly two drugs: Resmetirom (Rezdiffra®) is the first specific tablet that acts directly to reduce liver scarring (fibrosis). At the same time, Semaglutide (Wegovy®) injections treat the root causes by eliminating inflammation in more than half of patients also suffering from overweight or diabetes.”
