Aim: This study aimed to compare the pathological features of liver fibrosis in patients with alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH), focusing on clinical, biochemical, and histopathological characteristics. Material and Methods: This observational, comparative study included 160 patients diagnosed with liver fibrosis due to ASH or NASH, with 80 patients in each group. Data were collected from electronic medical records, including demographic, clinical, and laboratory parameters. Liver biopsies were assessed histologically for fibrosis stage (METAVIR) and pathological features such as steatosis, hepatocyte ballooning, and Mallory-Denk bodies. Statistical analysis included chi-square tests and independent t-tests, with a significance level of p < 0.05. Results: NASH patients exhibited significantly higher BMI (31.45 ± 4.82 kg/m² vs. 25.65 ± 3.21 kg/m², p < 0.001) and metabolic comorbidities such as diabetes (47.50% vs. 12.50%, p < 0.001) and dyslipidemia (62.50% vs. 15.00%, p < 0.001). Histologically, steatosis was more prevalent in NASH (93.75% vs. 37.50%, p < 0.001), while Mallory-Denk bodies were more common in ASH (68.75% vs. 37.50%, p < 0.001). Pericellular fibrosis and portal inflammation were significantly higher in NASH (87.50% and 75.00%) than in ASH (56.25% and 50.00%, p < 0.001). Fibrosis staging revealed mild fibrosis (F1) was more frequent in NASH (31.25%) than in ASH (18.75%, p = 0.045). Conclusion: ASH and NASH exhibit distinct pathological profiles despite overlapping features. ASH is characterized by Mallory-Denk bodies, while NASH shows greater pericellular fibrosis and portal inflammation. These findings underscore the need for tailored diagnostic and therapeutic strategies for ASH and NASH to mitigate disease progression effectively.