Original Contribution

The American Journal of Gastroenterology (2003) 98, 2485–2490; doi:10.1111/j.1572-0241.2003.08699.x

Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the view of the US Department of the Army or the US Department of Defense.

Stephen A Harrison MD1, Sigurd Torgerson MD1,4, Paul Hayashi MD3, John Ward PhD1,5 and Steven Schenker MD2

  1. 1Brooke Army Medical Center, University of Texas Health Science Center San Antonio San Antonio, Texas, USA
  2. 2Wilford Hall Medical Center, Departments of Gastroenterology, Lackland Air Force Base, Texas, USA
  3. 3University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  4. 4Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  5. 5Department of Clinical Investigation, San Antonio, Texas, USA

Correspondence: Stephen A Harrison, MD, Brooke Army Medical Center, Division of Gastroenterology and Hepatology, Ft. Sam Houston, Texas 78234, USA.

Received 17 January 2003; Accepted 25 March 2003.





Nonalcoholic steatohepatitis (NASH) is a common cause of liver disease. Although usually indolent, this disease can progress to cirrhosis in some patients. There is currently no proven medical therapy for the treatment of NASH. The aim of our study was to evaluate the efficacy of combination alpha-tocopherol (vitamin E) and vitamin C in reducing histologic inflammation and fibrosis.



This was a prospective, double-blind, randomized, placebo-controlled trial with a total enrollment of 49 patients; 45 patients completed the study. All patients were randomized to receive either vitamins E and C (1000 IU and 1000 mg, respectively) or placebo daily for 6 months, based on their initial histologic diagnosis of NASH. Additionally, all patients were given standard weight-loss counseling and encouraged to follow a low fat diet (<30 fat g/day). The pre- and posttreatment liver biopsies were reviewed by a single pathologist, who was blinded to the patient's medication. Biopsies were scored based on a modification of the scoring system published by Brunt et al. (Am J Gastroenterol 1999;94:2467–74). A score of 0–4 was possible for fibrosis, and a score of 0–6 was possible for inflammation and hepatocyte degeneration and necrosis. In addition, body mass index, glycohemoglobin, lipids, and liver enzymes were followed throughout the study.



Forty-five patients completed 6 months of therapy without significant side effects. Vitamin treatment resulted in a statistically significant improvement in fibrosis score (p = 0.002). No changes were noted in inflammation with treatment.



Vitamin E and vitamin C, in the doses used in this study, were well tolerated and were effective in improving fibrosis scores in NASH patients. No improvement in necroinflammatory activity or ALT was seen with this combination of drug therapy. A larger, multicenter, longer-term trial with vitamin E and vitamin C seems to be warranted.