Hi, How are you? Fatty liver can be caused by excessive alcohol intake (Alcoholic steato hepatitis, ASH) or due to excessive fatty food intake and sedentary life style (Non-alcoholic steato hepatitis, NASH). ASH is usually the beginning stages of alcohol induced liver damage and is completely reversible if the patient refrains from alcohol. NASH is being much more commonly diagnosed currently owing to poor dietary habits and sedentary life styles of people. High caloric intake, high fatty food intake and poor exercise regimens lead to deposition of fat goblets in the liver tissue leading to fatty liver (which shows up as increased echo texture on USG). This is also completely reversible in the initial stages if caloric intake is limited and exercise regimens are adhered to. If left un-checked, patients usually become obese, diabetic and in final stages may lead to cirrhosis of the liver which will necessitate a liver transplant. I would suggest a healthy diet and exercise regimen. Although there is no time limit on when to get a repeat scan, I would suggest one, once you have succeeded in losing some weight. Regarding your hernia, I presume it is hiatal hernia (as it was diagnosed during endoscopy). This usually does not need any treatment other than over teh counter ant-acids (omeprazole, pantoprazole etc), but if you are having a lot of heart burn or reflux, then a simple surgery (fundoplication) will be curative. Hope this helped and please do not hesitate to contact me for further details - rxsuresh@gmail.com