IDIOPATHIC STEATOHEPATITIS IN CHILDHOOD - A MULTICENTER RETROSPECTIVESTUDY

Objective: To describe the clinical, laboratory, and histopathologic f eatures of Idiopathic steatohepatitis in children. Study design: Retro spective review of all liver biopsies performed at Boston Children's H ospital, Massachusetts General Hospital, and the University of Massach usetts Medical Center from 1991 to 1994. Chart review was performed wh en biopsies demonstrated steatosis. Results: Eighty-two patients had b iopsy-proven hepatic steatosis. Fourteen patients had fatty liver with out evidence of inherited, infectious, autoimmune, endocrinologic, tox icologic, or iatrogenic causes. All 14 patients were obese, averaging 159% of ideal body weight(range, 121% to 222%), Nine patients initiall y had transient abdominal pain, two had hepatomegaly, and one was iden tified by incidental laboratory evaluation. These 12 patients had biop sies because of persistent elevations of aminotransferase levels. Two other patients without risk factors for steatosis were identified at s taging laparotomy for Hodgkin lymphoma. The 10 boys and 4 girls had an average age of 13.5 years (range, 10 to 18 years). Aminotransferase e levations were modest, with aspartate aminotransferase and alanine ami notransferase values averaging 77 +/- 38 IU and 129 +/- 73 IU, respect ively. All had imaging studies demonstrating diffuse fatty change. His tologic examination of biopsy specimens revealed varying degrees of st eatosis with inflammation and fibrosis. Conclusion: Idiopathic steatoh epatitis occurs predominantly or exclusively in obese peripubertal chi ldren. This entity represents a frequent reason far liver biopsy in th is age group. The degree of steatosis, fibrosis, and inflammation does not correlate with symptoms or signs, and significant liver injury wi th bridging fibrosis may be present.