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For more severe or persistent symptoms, proton pump inhibitors (PPIs) such as omeprazole or esomeprazole provide the most potent acid suppression and are typically prescribed for an 8-week trial, then stepped down to the lowest effective dose

e.g., a course of 3

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Several modes of cell death (apoptosis, necroptosis and pyroptosis) have been described in NASH and linked to lipotoxicity-induced cell death

In UK practice, monitoring is primarily based on clinical response rather than routine blood tests, as post-treatment serum B12 measurements can be misleadingly high and may not reflect tissue levels