Steatohepatitis (NASH \/ MASLD): Diagnosis, Fibrosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"La NASH ou MASLD est une st\u00e9atoh\u00e9patite non alcoolique pouvant \u00e9voluer vers la cirrhose et le carcinome h\u00e9patocellulaire. 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24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n La st\u00e9atoh\u00e9patite non alcoolique \u2014 historiquement d\u00e9sign\u00e9e NASH (<em>Non-Alcoholic SteatoHepatitis<\/em>) and recently renamed MASH (<em>Metabolic Dysfunction-Associated Steatohepatitis<\/em>) within the framework of the new MASLD nomenclature (<em>Metabolic dysfunction-Associated Steatotic Liver Disease<\/em>) adopt\u00e9e par les soci\u00e9t\u00e9s savantes internationales en 2023 pour remplacer les termes NAFLD et NASH \u2014 est la forme inflammatoire et fibroseuse de la st\u00e9atose h\u00e9patique m\u00e9tabolique, caract\u00e9ris\u00e9e histologiquement par la triade de st\u00e9atose (accumulation de triglyc\u00e9rides dans les h\u00e9patocytes) + inflammation lobulaire (infiltrat de polynucl\u00e9aires neutrophiles et de lymphocytes) + ballonnisation h\u00e9patocytaire (d\u00e9g\u00e9n\u00e9rescence des h\u00e9patocytes \u2014 marqueur de mort cellulaire) + avec ou sans fibrose \u2014 sur une biopsie h\u00e9patique, en l'absence de consommation alcoolique significative (< 20 g\/jour chez la femme + < 30 g\/jour chez l'homme) et en pr\u00e9sence d'au moins un facteur de risque m\u00e9tabolique (surpoids + ob\u00e9sit\u00e9 + diab\u00e8te de type 2 + hypertriglyc\u00e9rid\u00e9mie + hypertension art\u00e9rielle). Avec une pr\u00e9valence de la st\u00e9atose h\u00e9patique de 25\u201330 % dans les pays occidentaux (dont 5\u201310 % avec st\u00e9atoh\u00e9patite inflammatoire active) et une incidence en augmentation parall\u00e8le \u00e0 l'\u00e9pid\u00e9mie d'ob\u00e9sit\u00e9 et de diab\u00e8te de type 2, la MASLD est devenue la maladie h\u00e9patique chronique la plus fr\u00e9quente dans le monde et la principale indication de transplantation h\u00e9patique en progression dans les pays d\u00e9velopp\u00e9s. Son importance pronostique tient \u00e0 sa capacit\u00e9 d'\u00e9volution \u2014 chez une minorit\u00e9 significative de patients \u2014 vers la fibrose avanc\u00e9e + la cirrhose (10\u201320 % \u00e0 20 ans pour les formes avec NASH actif) + le carcinome h\u00e9patocellulaire (CHC \u2014 qui peut survenir sans cirrhose pr\u00e9alable dans la MASLD) + l'insuffisance h\u00e9patique terminale. En mars 2024, la FDA am\u00e9ricaine a approuv\u00e9 le r\u00e9sm\u00e9tirome (Rezdiffra\u00ae) comme premier traitement pharmacologique sp\u00e9cifiquement approuv\u00e9 pour la MASH avec fibrose \u2265 F2 \u2014 marquant une \u00e9tape majeure apr\u00e8s des d\u00e9cennies de prise en charge uniquement bas\u00e9e sur les modifications du mode de vie.\n <\/div>\n\n <h2>Histological appearance and stages of fibrosis<\/h2>\n <ul class=\"co-list\">\n <li><strong>St\u00e9atose simple (MASLD sans MASH \u2014 anciennement NAFL) :<\/strong> accumulation of triglycerides in \u2265 5 % of hepatocytes + without inflammation + nor ballooning + nor significant fibrosis \u2192 favorable prognosis + progression to fibrosis slow (2\u20133 % per year to F1) + treatment = lifestyle changes + liver monitoring<\/li>\n <li><strong>St\u00e9atoh\u00e9patite active (MASH \u2014 anciennement NASH) :<\/strong> Steatosis + lobular inflammation + hepatocyte ballooning + \u00b1 Mallory-Denk bodies + \u00b1 apoptosis \u2192 progressive form + risk of fibrosis + cirrhosis + HCC \u2192 requires active management + potentially pharmacological treatment<\/li>\n <li><strong>Fibrose h\u00e9patique \u2014 stades (syst\u00e8me de Metavir ou syst\u00e8me de Kleiner pour la MASLD) :<\/strong> F0 = absent + F1 = mild perisinusoidal or portal fibrosis + F2 = moderate perisinusoidal and portal fibrosis + F3 = bridging fibrosis (fibrous septa connecting portal spaces) + F4 = cirrhosis (entirely destroyed lobular architecture with regenerative nodules)<\/li>\n <li><strong>Risk of progression:<\/strong> Simple steatosis \u2192 cirrhosis: very rare + MASH F0\u2013F1 \u2192 cirrhosis: 5\u201310 % at 10 years + MASH F2\u2013F3 \u2192 cirrhosis: 20\u201330 % at 10 years + MASH F4 (cirrhosis) \u2192 HCC: 1\u20132 % per year (higher than alcoholic or viral cirrhosis without screening)<\/li>\n <\/ul>\n\n <h2>Physiopathologie \u2014 mod\u00e8le multi-hits<\/h2>\n <ul class=\"co-list\">\n <li><strong>Premier hit \u2014 st\u00e9atose h\u00e9patique :<\/strong> insulin resistance \u2192 excessive influx of free fatty acids into the liver (increased peripheral lipolysis + gluconeogenesis) + increased hepatic triglyceride synthesis + reduced VLDL export \u2192 intrahepatic triglyceride accumulation<\/li>\n <li><strong>Deuxi\u00e8me hit \u2014 stress oxydatif et inflammation :<\/strong> Mitochondrial fatty acid oxidation \u2192 excessive ROS (reactive oxygen species) production \u2192 lipid peroxidation \u2192 membrane damage \u2192 activation of cell death pathways (apoptosis + necrosis) \u2192 release of DAMPs (damage-associated molecular patterns) \u2192 Kupffer cell activation \u2192 production of pro-inflammatory cytokines (TNF-\u03b1 + IL-6 + IL-1\u03b2) \u2192 neutrophil recruitment \u2192 lobular inflammation<\/li>\n <li><strong>Troisi\u00e8me hit \u2014 activation des cellules stellaires et fibrog\u00e9n\u00e8se :<\/strong> Fibrogenic cytokines (TGF-\u03b2 + PDGF) produced by activated macrophages + injured hepatocytes \u2192 activation of hepatic stellate cells (Ito cells) \u2192 transformation into myofibroblasts \u2192 collagen production \u2192 progressive fibrosis<\/li>\n <li><strong>R\u00f4le du microbiome intestinal :<\/strong> Intestinal dysbiosis \u2192 increased intestinal permeability \u2192 bacterial translocation (LPS + SCFAs) into the portal vein \u2192 activation of Kupffer cell TLR4 receptors \u2192 amplified liver inflammation<\/li>\n <\/ul>\n\n <h2>\u00c9valuation non invasive de la fibrose<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Test<\/th>\n <th>Calcul \/ M\u00e9thode<\/th>\n <th>Interpretation<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>FIB-4 (Fibrosis-4 index)<\/td>\n <td>FIB-4 = (\u00e2ge \u00d7 ASAT) \/ (plaquettes \u00d7 \u221aALAT) + calcul\u00e9 \u00e0 partir des r\u00e9sultats biologiques courants<\/td>\n <td>FIB-4 < 1,30 = fibrose avanc\u00e9e peu probable (VPN 90 %) \u2192 surveillance simple + FIB-4 1,30\u20132,67 = zone interm\u00e9diaire \u2192 \u00e9lastographie recommand\u00e9e + FIB-4 > 2,67 = fibrose avanc\u00e9e probable (F3\u2013F4) \u2192 r\u00e9f\u00e9rence h\u00e9patologique + le FIB-4 est le test non invasif de premi\u00e8re intention recommand\u00e9 par les lignes directrices EASL et AASLD<\/td>\n <\/tr>\n <tr>\n <td>NFS (NAFLD Fibrosis Score)<\/td>\n <td>Utilise : \u00e2ge + IMC + glyc\u00e9mie + plaquettes + albumine + ratio ASAT\/ALAT<\/td>\n <td>Score < \u22121,455 = fibrose avanc\u00e9e peu probable + Score > 0,676 = fibrose avanc\u00e9e probable \u2192 moins utilis\u00e9 que le FIB-4 en pratique<\/td>\n <\/tr>\n <tr>\n <td>\u00c9lastographie h\u00e9patique (FibroScan \u2014 ELT)<\/td>\n <td>Mesure de la rigidit\u00e9 h\u00e9patique par onde de cisaillement + kPa + examen non invasif + ambulatoire + 10 min<\/td>\n <td>Rigidit\u00e9 < 7 kPa = fibrose l\u00e9g\u00e8re (F0\u2013F1) + 7\u20139 kPa = F2 + 9\u201311 kPa = F3 + > 11\u201313 kPa = F4 (cirrhose) + les valeurs seuils varient selon la cause de la maladie h\u00e9patique + repas r\u00e9cent \u2192 surestimation \u2192 \u00e0 faire \u00e0 jeun + l'IMC \u00e9lev\u00e9 r\u00e9duit la fiabilit\u00e9 (capteur XL pour ob\u00e8se)<\/td>\n <\/tr>\n <tr>\n <td>Biopsie h\u00e9patique (gold standard)<\/td>\n <td>Pr\u00e9l\u00e8vement d'un fragment de parenchyme h\u00e9patique (percutan\u00e9e ou transjugulaire) \u2192 examen histologique + score NAS (NAFLD Activity Score) + score de fibrose<\/td>\n <td>Seul examen permettant de confirmer le diagnostic de MASH + de grader l'activit\u00e9 (NAS \u2265 5 = MASH active) + de stadifier la fibrose pr\u00e9cis\u00e9ment \u2192 indiqu\u00e9e si tests non invasifs discordants + ou avant initiation d'un traitement pharmacologique dans les essais cliniques + risque de complications : saignement 0,5 % + douleur + d\u00e9c\u00e8s < 0,01 %<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Le FIB-4 est calculable imm\u00e9diatement \u00e0 partir des r\u00e9sultats biologiques courants (\u00e2ge + ASAT + ALAT + plaquettes) sans co\u00fbt suppl\u00e9mentaire et est recommand\u00e9 comme test de triage de premi\u00e8re intention chez tout patient diab\u00e9tique de type 2 ou ob\u00e8se pour d\u00e9pister une fibrose h\u00e9patique avanc\u00e9e li\u00e9e \u00e0 la MASLD \u2014 population dans laquelle la pr\u00e9valence de la MASLD avec fibrose avanc\u00e9e atteint 10\u201320 %. Un FIB-4 < 1,30 est rassurant et ne n\u00e9cessite pas d'investigation suppl\u00e9mentaire \u00e0 court terme.<\/span>\n <\/div>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Perte de poids (traitement central \u2014 toutes les formes) :<\/strong> perte de \u2265 5 % du poids corporel \u2192 r\u00e9duction de la st\u00e9atose + am\u00e9lioration des transaminases + perte de \u2265 7\u201310 % \u2192 r\u00e9solution de la MASH active dans 60\u201380 % des cas + r\u00e9gression de la fibrose dans 30\u201340 % des cas + perte de > 10 % \u2192 r\u00e9gression de la fibrose m\u00eame avanc\u00e9e dans certains cas + r\u00e9gime hypocalorique (d\u00e9ficit de 500\u20131 000 kcal\/jour) + activit\u00e9 physique (150 min\/semaine d'a\u00e9robie mod\u00e9r\u00e9e) + r\u00e9gime m\u00e9diterran\u00e9en pr\u00e9f\u00e9r\u00e9<\/li>\n <li><strong>R\u00e9sm\u00e9tirome (Rezdiffra\u00ae \u2014 premier traitement approuv\u00e9 FDA mars 2024) :<\/strong> Selective hepatic thyroid hormone receptor beta-1 (THR-\u03b2) agonist \u2192 activation of hepatic lipid metabolism \u2192 reduction of steatosis, inflammation, and fibrosis + Dosage: 80 mg or 100 mg orally once daily + Approved for patients with confirmed MASH + fibrosis F2\u2013F3 + MAESTRO-NASH trial results: MASH resolution without worsening fibrosis: 29.9 % vs 9.7 % (placebo) + Fibrosis improvement \u2265 1 stage without worsening activity: 24.2 % vs 14.2 % + Not yet approved by Health Canada (access via Special Access Program or clinical studies)<\/li>\n <li><strong>S\u00e9maglutide (Ozempic\u00ae + Wegovy\u00ae) \u2014 donn\u00e9es prometteuses :<\/strong> GLP-1 agonist \u2192 significant weight reduction + improved steatosis + inflammation + Phase 3 ESSENCE trial (2024 results): demonstrated MASH resolution and fibrosis improvement \u2192 semaglutide 2.4 mg\/week SC = cornerstone treatment for MASH with obesity pending specific approval<\/li>\n <li><strong>Tirzepatide (Mounjaro\u00ae \u2014 double agoniste GLP-1 + GIP) :<\/strong> SYNERGY-NASH trial data promising + MASH resolution + fibrosis improvement + awaiting specific approval<\/li>\n <li><strong>Traitement des comorbidit\u00e9s m\u00e9taboliques :<\/strong> Type 2 diabetes control (prefer SGLT2 and GLP-1) + dyslipidemia treatment (statins - safe in MASLD despite elevated transaminases - DO NOT contraindicate them) + hypertension treatment (ACE inhibitors or ARBs - hepatoprotective effects) + complete alcohol withdrawal<\/li>\n <li><strong>Bariatric surgery:<\/strong> if severe obesity (BMI \u2265 35 + comorbidities + or BMI \u2265 40) + MASH resolution in 80\u201390 % of cases + fibrosis regression + reduced risk of HCC + sleeve gastrectomy + Roux-en-Y gastric bypass<\/li>\n <li><strong>Surveillance du carcinome h\u00e9patocellulaire (CHC) :<\/strong> MASLD cirrhosis: hepatic ultrasound + alpha-fetoprotein every 6 months (standard for HCC surveillance on cirrhosis) + if MASH without cirrhosis: low but not zero HCC risk \u2192 monitor if advanced fibrosis F3<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin si un bilan h\u00e9patique de routine montre une \u00e9l\u00e9vation persistante des transaminases (ALAT + ASAT) chez un patient ob\u00e8se ou diab\u00e9tique \u2014 ces anomalies peuvent t\u00e9moigner d'une st\u00e9atoh\u00e9patite active n\u00e9cessitant un bilan de fibrose (FIB-4 + \u00e9lastographie). Un FIB-4 > 2,67 ou une \u00e9lastographie \u2265 9\u201311 kPa doit conduire \u00e0 une r\u00e9f\u00e9rence h\u00e9patologique pour \u00e9valuation de la fibrose avanc\u00e9e et discussion des options th\u00e9rapeutiques. Pour le calcul du FIB-4, la prescription de l'\u00e9lastographie et l'initiation de la prise en charge m\u00e9tabolique, Clinique Omicron offre des consultations dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron d\u00e9pistent la MASLD chez les patients ob\u00e8ses + diab\u00e9tiques + ou avec syndrome m\u00e9tabolique, calculent le FIB-4 \u00e0 partir du bilan h\u00e9patique courant, prescrivent l'\u00e9lastographie h\u00e9patique (FibroScan) si FIB-4 interm\u00e9diaire ou \u00e9lev\u00e9, initient les modifications du mode de vie (r\u00e9gime m\u00e9diterran\u00e9en + exercice + perte de poids) et optimisent le traitement des comorbidit\u00e9s m\u00e9taboliques (SGLT2 + GLP-1 + statines + IEC), orientent vers la gastroent\u00e9rologie et l'h\u00e9patologie pour les formes avec fibrose avanc\u00e9e ou candidats \u00e0 la biopsie ou aux nouveaux traitements pharmacologiques. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un h\u00e9patologue. La terminologie MASLD\/MASH a remplac\u00e9 NAFLD\/NASH dans la nomenclature internationale depuis 2023. Le r\u00e9sm\u00e9tirome (Rezdiffra\u00ae) n'est pas encore approuv\u00e9 par Sant\u00e9 Canada \u2014 son acc\u00e8s au Qu\u00e9bec est limit\u00e9 aux essais cliniques ou \u00e0 des programmes d'acc\u00e8s sp\u00e9ciaux. Les statines ne sont PAS contre-indiqu\u00e9es dans la MASLD m\u00eame avec \u00e9l\u00e9vation mod\u00e9r\u00e9e des transaminases.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>St\u00e9atoh\u00e9patite (NASH \/ MASLD) : diagnostic, fibrose et traitement | Clinique Omicron Gastroent\u00e9rologie & H\u00e9patologie & M\u00e9decine de famille St\u00e9atoh\u00e9patite non alcoolique (NASH \/ MASLD) La st\u00e9atoh\u00e9patite non alcoolique \u2014 historiquement d\u00e9sign\u00e9e NASH (Non-Alcoholic SteatoHepatitis) et r\u00e9cemment renomm\u00e9e MASH (Metabolic dysfunction-Associated SteatoHepatitis) dans le cadre de la nouvelle nomenclature MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease)… <a href=\"https:\/\/cliniqueomicron.ca\/en\/steatohepatite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Steatohepatitis (NASH \/ MASLD): Diagnosis, Fibrosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"St\u00e9atoh\u00e9patite (NASH) | Brossard | Clinique Omicron","_metasync_otto_description":"St\u00e9atoh\u00e9patite (NASH) St\u00e9atoh\u00e9patite (NASH) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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FIB-4 \u00e9lastographie FibroScan fibrose F2-F4, r\u00e9sm\u00e9tirome Rezdiffra FDA 2024 approuv\u00e9, s\u00e9maglutide perte poids au Qu\u00e9bec.","_metasync_seo_title":"St\u00e9atoh\u00e9patite (NASH) | Clinique Omicron","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_imported_seo_title":"","_metasync_imported_seo_desc":"","_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-09-03T07:54:33+00:00\"}","_metasync_robots_advanced":"","_metasync_og_title":"Steatohepatite | Clinique Omicron Qu\u00e9bec","_metasync_og_description":"St\u00e9atoh\u00e9patite (NASH) St\u00e9atoh\u00e9patite (NASH) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n La st\u00e9atoh\u00e9patite non alcoolique \u2014 historiquement d\u00e9sign\u00e9e NASH (<em>Non-Alcoholic SteatoHepatitis<\/em>) and recently renamed MASH (<em>Metabolic Dysfunction-Associated Steatohepatitis<\/em>) within the framework of the new MASLD nomenclature (<em>Metabolic dysfunction-Associated Steatotic Liver Disease<\/em>) adopt\u00e9e par les soci\u00e9t\u00e9s savantes internationales en 2023 pour remplacer les termes NAFLD et NASH \u2014 est la forme inflammatoire et fibroseuse de la st\u00e9atose h\u00e9patique m\u00e9tabolique, caract\u00e9ris\u00e9e histologiquement par la triade de st\u00e9atose (accumulation de triglyc\u00e9rides dans les h\u00e9patocytes) + inflammation lobulaire (infiltrat de polynucl\u00e9aires neutrophiles et de lymphocytes) + ballonnisation h\u00e9patocytaire (d\u00e9g\u00e9n\u00e9rescence des h\u00e9patocytes \u2014 marqueur de mort cellulaire) + avec ou sans fibrose \u2014 sur une biopsie h\u00e9patique, en l'absence de consommation alcoolique significative (< 20 g\/jour chez la femme + < 30 g\/jour chez l'homme) et en pr\u00e9sence d'au moins un facteur de risque m\u00e9tabolique (surpoids + ob\u00e9sit\u00e9 + diab\u00e8te de type 2 + hypertriglyc\u00e9rid\u00e9mie + hypertension art\u00e9rielle). Avec une pr\u00e9valence de la st\u00e9atose h\u00e9patique de 25\u201330 % dans les pays occidentaux (dont 5\u201310 % avec st\u00e9atoh\u00e9patite inflammatoire active) et une incidence en augmentation parall\u00e8le \u00e0 l'\u00e9pid\u00e9mie d'ob\u00e9sit\u00e9 et de diab\u00e8te de type 2, la MASLD est devenue la maladie h\u00e9patique chronique la plus fr\u00e9quente dans le monde et la principale indication de transplantation h\u00e9patique en progression dans les pays d\u00e9velopp\u00e9s. Son importance pronostique tient \u00e0 sa capacit\u00e9 d'\u00e9volution \u2014 chez une minorit\u00e9 significative de patients \u2014 vers la fibrose avanc\u00e9e + la cirrhose (10\u201320 % \u00e0 20 ans pour les formes avec NASH actif) + le carcinome h\u00e9patocellulaire (CHC \u2014 qui peut survenir sans cirrhose pr\u00e9alable dans la MASLD) + l'insuffisance h\u00e9patique terminale. En mars 2024, la FDA am\u00e9ricaine a approuv\u00e9 le r\u00e9sm\u00e9tirome (Rezdiffra\u00ae) comme premier traitement pharmacologique sp\u00e9cifiquement approuv\u00e9 pour la MASH avec fibrose \u2265 F2 \u2014 marquant une \u00e9tape majeure apr\u00e8s des d\u00e9cennies de prise en charge uniquement bas\u00e9e sur les modifications du mode de vie.\n <\/div>\n\n <h2>Histological appearance and stages of fibrosis<\/h2>\n <ul class=\"co-list\">\n <li><strong>St\u00e9atose simple (MASLD sans MASH \u2014 anciennement NAFL) :<\/strong> accumulation of triglycerides in \u2265 5 % of hepatocytes + without inflammation + nor ballooning + nor significant fibrosis \u2192 favorable prognosis + progression to fibrosis slow (2\u20133 % per year to F1) + treatment = lifestyle changes + liver monitoring<\/li>\n <li><strong>St\u00e9atoh\u00e9patite active (MASH \u2014 anciennement NASH) :<\/strong> Steatosis + lobular inflammation + hepatocyte ballooning + \u00b1 Mallory-Denk bodies + \u00b1 apoptosis \u2192 progressive form + risk of fibrosis + cirrhosis + HCC \u2192 requires active management + potentially pharmacological treatment<\/li>\n <li><strong>Fibrose h\u00e9patique \u2014 stades (syst\u00e8me de Metavir ou syst\u00e8me de Kleiner pour la MASLD) :<\/strong> F0 = absent + F1 = mild perisinusoidal or portal fibrosis + F2 = moderate perisinusoidal and portal fibrosis + F3 = bridging fibrosis (fibrous septa connecting portal spaces) + F4 = cirrhosis (entirely destroyed lobular architecture with regenerative nodules)<\/li>\n <li><strong>Risk of progression:<\/strong> Simple steatosis \u2192 cirrhosis: very rare + MASH F0\u2013F1 \u2192 cirrhosis: 5\u201310 % at 10 years + MASH F2\u2013F3 \u2192 cirrhosis: 20\u201330 % at 10 years + MASH F4 (cirrhosis) \u2192 HCC: 1\u20132 % per year (higher than alcoholic or viral cirrhosis without screening)<\/li>\n <\/ul>\n\n <h2>Physiopathologie \u2014 mod\u00e8le multi-hits<\/h2>\n <ul class=\"co-list\">\n <li><strong>Premier hit \u2014 st\u00e9atose h\u00e9patique :<\/strong> insulin resistance \u2192 excessive influx of free fatty acids into the liver (increased peripheral lipolysis + gluconeogenesis) + increased hepatic triglyceride synthesis + reduced VLDL export \u2192 intrahepatic triglyceride accumulation<\/li>\n <li><strong>Deuxi\u00e8me hit \u2014 stress oxydatif et inflammation :<\/strong> Mitochondrial fatty acid oxidation \u2192 excessive ROS (reactive oxygen species) production \u2192 lipid peroxidation \u2192 membrane damage \u2192 activation of cell death pathways (apoptosis + necrosis) \u2192 release of DAMPs (damage-associated molecular patterns) \u2192 Kupffer cell activation \u2192 production of pro-inflammatory cytokines (TNF-\u03b1 + IL-6 + IL-1\u03b2) \u2192 neutrophil recruitment \u2192 lobular inflammation<\/li>\n <li><strong>Troisi\u00e8me hit \u2014 activation des cellules stellaires et fibrog\u00e9n\u00e8se :<\/strong> Fibrogenic cytokines (TGF-\u03b2 + PDGF) produced by activated macrophages + injured hepatocytes \u2192 activation of hepatic stellate cells (Ito cells) \u2192 transformation into myofibroblasts \u2192 collagen production \u2192 progressive fibrosis<\/li>\n <li><strong>R\u00f4le du microbiome intestinal :<\/strong> Intestinal dysbiosis \u2192 increased intestinal permeability \u2192 bacterial translocation (LPS + SCFAs) into the portal vein \u2192 activation of Kupffer cell TLR4 receptors \u2192 amplified liver inflammation<\/li>\n <\/ul>\n\n <h2>\u00c9valuation non invasive de la fibrose<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Test<\/th>\n <th>Calcul \/ M\u00e9thode<\/th>\n <th>Interpretation<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>FIB-4 (Fibrosis-4 index)<\/td>\n <td>FIB-4 = (\u00e2ge \u00d7 ASAT) \/ (plaquettes \u00d7 \u221aALAT) + calcul\u00e9 \u00e0 partir des r\u00e9sultats biologiques courants<\/td>\n <td>FIB-4 < 1,30 = fibrose avanc\u00e9e peu probable (VPN 90 %) \u2192 surveillance simple + FIB-4 1,30\u20132,67 = zone interm\u00e9diaire \u2192 \u00e9lastographie recommand\u00e9e + FIB-4 > 2,67 = fibrose avanc\u00e9e probable (F3\u2013F4) \u2192 r\u00e9f\u00e9rence h\u00e9patologique + le FIB-4 est le test non invasif de premi\u00e8re intention recommand\u00e9 par les lignes directrices EASL et AASLD<\/td>\n <\/tr>\n <tr>\n <td>NFS (NAFLD Fibrosis Score)<\/td>\n <td>Utilise : \u00e2ge + IMC + glyc\u00e9mie + plaquettes + albumine + ratio ASAT\/ALAT<\/td>\n <td>Score < \u22121,455 = fibrose avanc\u00e9e peu probable + Score > 0,676 = fibrose avanc\u00e9e probable \u2192 moins utilis\u00e9 que le FIB-4 en pratique<\/td>\n <\/tr>\n <tr>\n <td>\u00c9lastographie h\u00e9patique (FibroScan \u2014 ELT)<\/td>\n <td>Mesure de la rigidit\u00e9 h\u00e9patique par onde de cisaillement + kPa + examen non invasif + ambulatoire + 10 min<\/td>\n <td>Rigidit\u00e9 < 7 kPa = fibrose l\u00e9g\u00e8re (F0\u2013F1) + 7\u20139 kPa = F2 + 9\u201311 kPa = F3 + > 11\u201313 kPa = F4 (cirrhose) + les valeurs seuils varient selon la cause de la maladie h\u00e9patique + repas r\u00e9cent \u2192 surestimation \u2192 \u00e0 faire \u00e0 jeun + l'IMC \u00e9lev\u00e9 r\u00e9duit la fiabilit\u00e9 (capteur XL pour ob\u00e8se)<\/td>\n <\/tr>\n <tr>\n <td>Biopsie h\u00e9patique (gold standard)<\/td>\n <td>Pr\u00e9l\u00e8vement d'un fragment de parenchyme h\u00e9patique (percutan\u00e9e ou transjugulaire) \u2192 examen histologique + score NAS (NAFLD Activity Score) + score de fibrose<\/td>\n <td>Seul examen permettant de confirmer le diagnostic de MASH + de grader l'activit\u00e9 (NAS \u2265 5 = MASH active) + de stadifier la fibrose pr\u00e9cis\u00e9ment \u2192 indiqu\u00e9e si tests non invasifs discordants + ou avant initiation d'un traitement pharmacologique dans les essais cliniques + risque de complications : saignement 0,5 % + douleur + d\u00e9c\u00e8s < 0,01 %<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Le FIB-4 est calculable imm\u00e9diatement \u00e0 partir des r\u00e9sultats biologiques courants (\u00e2ge + ASAT + ALAT + plaquettes) sans co\u00fbt suppl\u00e9mentaire et est recommand\u00e9 comme test de triage de premi\u00e8re intention chez tout patient diab\u00e9tique de type 2 ou ob\u00e8se pour d\u00e9pister une fibrose h\u00e9patique avanc\u00e9e li\u00e9e \u00e0 la MASLD \u2014 population dans laquelle la pr\u00e9valence de la MASLD avec fibrose avanc\u00e9e atteint 10\u201320 %. Un FIB-4 < 1,30 est rassurant et ne n\u00e9cessite pas d'investigation suppl\u00e9mentaire \u00e0 court terme.<\/span>\n <\/div>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Perte de poids (traitement central \u2014 toutes les formes) :<\/strong> perte de \u2265 5 % du poids corporel \u2192 r\u00e9duction de la st\u00e9atose + am\u00e9lioration des transaminases + perte de \u2265 7\u201310 % \u2192 r\u00e9solution de la MASH active dans 60\u201380 % des cas + r\u00e9gression de la fibrose dans 30\u201340 % des cas + perte de > 10 % \u2192 r\u00e9gression de la fibrose m\u00eame avanc\u00e9e dans certains cas + r\u00e9gime hypocalorique (d\u00e9ficit de 500\u20131 000 kcal\/jour) + activit\u00e9 physique (150 min\/semaine d'a\u00e9robie mod\u00e9r\u00e9e) + r\u00e9gime m\u00e9diterran\u00e9en pr\u00e9f\u00e9r\u00e9<\/li>\n <li><strong>R\u00e9sm\u00e9tirome (Rezdiffra\u00ae \u2014 premier traitement approuv\u00e9 FDA mars 2024) :<\/strong> Selective hepatic thyroid hormone receptor beta-1 (THR-\u03b2) agonist \u2192 activation of hepatic lipid metabolism \u2192 reduction of steatosis, inflammation, and fibrosis + Dosage: 80 mg or 100 mg orally once daily + Approved for patients with confirmed MASH + fibrosis F2\u2013F3 + MAESTRO-NASH trial results: MASH resolution without worsening fibrosis: 29.9 % vs 9.7 % (placebo) + Fibrosis improvement \u2265 1 stage without worsening activity: 24.2 % vs 14.2 % + Not yet approved by Health Canada (access via Special Access Program or clinical studies)<\/li>\n <li><strong>S\u00e9maglutide (Ozempic\u00ae + Wegovy\u00ae) \u2014 donn\u00e9es prometteuses :<\/strong> GLP-1 agonist \u2192 significant weight reduction + improved steatosis + inflammation + Phase 3 ESSENCE trial (2024 results): demonstrated MASH resolution and fibrosis improvement \u2192 semaglutide 2.4 mg\/week SC = cornerstone treatment for MASH with obesity pending specific approval<\/li>\n <li><strong>Tirzepatide (Mounjaro\u00ae \u2014 double agoniste GLP-1 + GIP) :<\/strong> SYNERGY-NASH trial data promising + MASH resolution + fibrosis improvement + awaiting specific approval<\/li>\n <li><strong>Traitement des comorbidit\u00e9s m\u00e9taboliques :<\/strong> Type 2 diabetes control (prefer SGLT2 and GLP-1) + dyslipidemia treatment (statins - safe in MASLD despite elevated transaminases - DO NOT contraindicate them) + hypertension treatment (ACE inhibitors or ARBs - hepatoprotective effects) + complete alcohol withdrawal<\/li>\n <li><strong>Bariatric surgery:<\/strong> if severe obesity (BMI \u2265 35 + comorbidities + or BMI \u2265 40) + MASH resolution in 80\u201390 % of cases + fibrosis regression + reduced risk of HCC + sleeve gastrectomy + Roux-en-Y gastric bypass<\/li>\n <li><strong>Surveillance du carcinome h\u00e9patocellulaire (CHC) :<\/strong> MASLD cirrhosis: hepatic ultrasound + alpha-fetoprotein every 6 months (standard for HCC surveillance on cirrhosis) + if MASH without cirrhosis: low but not zero HCC risk \u2192 monitor if advanced fibrosis F3<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin si un bilan h\u00e9patique de routine montre une \u00e9l\u00e9vation persistante des transaminases (ALAT + ASAT) chez un patient ob\u00e8se ou diab\u00e9tique \u2014 ces anomalies peuvent t\u00e9moigner d'une st\u00e9atoh\u00e9patite active n\u00e9cessitant un bilan de fibrose (FIB-4 + \u00e9lastographie). Un FIB-4 > 2,67 ou une \u00e9lastographie \u2265 9\u201311 kPa doit conduire \u00e0 une r\u00e9f\u00e9rence h\u00e9patologique pour \u00e9valuation de la fibrose avanc\u00e9e et discussion des options th\u00e9rapeutiques. Pour le calcul du FIB-4, la prescription de l'\u00e9lastographie et l'initiation de la prise en charge m\u00e9tabolique, Clinique Omicron offre des consultations dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron d\u00e9pistent la MASLD chez les patients ob\u00e8ses + diab\u00e9tiques + ou avec syndrome m\u00e9tabolique, calculent le FIB-4 \u00e0 partir du bilan h\u00e9patique courant, prescrivent l'\u00e9lastographie h\u00e9patique (FibroScan) si FIB-4 interm\u00e9diaire ou \u00e9lev\u00e9, initient les modifications du mode de vie (r\u00e9gime m\u00e9diterran\u00e9en + exercice + perte de poids) et optimisent le traitement des comorbidit\u00e9s m\u00e9taboliques (SGLT2 + GLP-1 + statines + IEC), orientent vers la gastroent\u00e9rologie et l'h\u00e9patologie pour les formes avec fibrose avanc\u00e9e ou candidats \u00e0 la biopsie ou aux nouveaux traitements pharmacologiques. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un h\u00e9patologue. La terminologie MASLD\/MASH a remplac\u00e9 NAFLD\/NASH dans la nomenclature internationale depuis 2023. Le r\u00e9sm\u00e9tirome (Rezdiffra\u00ae) n'est pas encore approuv\u00e9 par Sant\u00e9 Canada \u2014 son acc\u00e8s au Qu\u00e9bec est limit\u00e9 aux essais cliniques ou \u00e0 des programmes d'acc\u00e8s sp\u00e9ciaux. Les statines ne sont PAS contre-indiqu\u00e9es dans la MASLD m\u00eame avec \u00e9l\u00e9vation mod\u00e9r\u00e9e des transaminases.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>St\u00e9atoh\u00e9patite (NASH \/ MASLD) : diagnostic, fibrose et traitement | Clinique Omicron Gastroent\u00e9rologie & H\u00e9patologie & M\u00e9decine de famille St\u00e9atoh\u00e9patite non alcoolique (NASH \/ MASLD) La st\u00e9atoh\u00e9patite non alcoolique \u2014 historiquement d\u00e9sign\u00e9e NASH (Non-Alcoholic SteatoHepatitis) et r\u00e9cemment renomm\u00e9e MASH (Metabolic dysfunction-Associated SteatoHepatitis) dans le cadre de la nouvelle nomenclature MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease)… <a href=\"https:\/\/cliniqueomicron.ca\/en\/steatohepatite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Steatohepatitis (NASH \/ MASLD): Diagnosis, Fibrosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"St\u00e9atoh\u00e9patite (NASH) | Brossard | Clinique Omicron","_metasync_otto_description":"St\u00e9atoh\u00e9patite (NASH) St\u00e9atoh\u00e9patite (NASH) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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FIB-4 \u00e9lastographie FibroScan fibrose F2-F4, r\u00e9sm\u00e9tirome Rezdiffra FDA 2024 approuv\u00e9, s\u00e9maglutide perte poids au Qu\u00e9bec.","_metasync_seo_title":"St\u00e9atoh\u00e9patite (NASH) | Clinique Omicron","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_imported_seo_title":"","_metasync_imported_seo_desc":"","_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-09-03T07:54:33+00:00\"}","_metasync_robots_advanced":"","_metasync_og_title":"Steatohepatite | Clinique Omicron Qu\u00e9bec","_metasync_og_description":"St\u00e9atoh\u00e9patite (NASH) St\u00e9atoh\u00e9patite (NASH) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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