Preventing and Treating Adult Liver Disease
We are well aware of the soaring rates of obesity in our nation, and the media has devoted much attention to health risks such as diabetes and heart disease associated with obesity. But another danger associated with obesity has received disproportionately low attention: non-alcoholic fatty liver disease.
Physicians at the Center for Liver Disease and Transplantation are observing a dramatic increase in the number of patients with chronic liver disease due to obesity. About 25% of U.S. adults now have evidence of fatty liver disease.
When people become insulin resistant and develop diabetes, fat can accumulate in the liver. This causes injury and inflammation that can progressively damage the liver. In some, the liver becomes so hardened that it no longer functions. Although many people with fatty liver disease do not develop serious liver problems, an estimated one fourth do progress to liver failure. At that stage, liver transplantation may be their only treatment option.
This disease process typically takes about 20 years, with symptoms appearing only in advanced stages. "People who are overweight, have diabetes, or have high cholesterol should think about the damage they may be doing to their liver and their bodies," says Scott A. Fink, MD, MPH, Assistant Professor of Medicine. "They should be screened regularly for insulin resistance, cholesterol, heart disease, and abnormal liver enzymes."
The center treats patients with all types of liver disease and at all stages of progression, but by the time symptoms appear, the disease has often progressed and has become far more difficult to treat.
"Chronic liver diseases are far more common than most people realize, but they are frequently asymptomatic at the early stages when they are best treated," according to Robert S. Brown, Jr., MD, MPH, Director, Center for Liver Disease and Transplantation.
Liver Transplantation for Bile Duct Cancer PatientsFor patients who are diagnosed with advanced cancer of the bile ducts (the tubes that carry bile from the liver to the gallbladder), options are usually limited to chemotherapy and palliative care. NewYork-Presbyterian Hospital/Columbia University Medical Center is one of the first hospitals anywhere to offer liver transplantation to these patients, giving them new hope for keeping their cancer at bay. The first three cases, one involving an organ donated from a living donor and the other two by deceased donors, were successful. Traditionally, transplantation for bile duct cancer was not possible due to high rates of recurrence after transplant. Recent research, combining advanced techniques in liver surgery with those of transplantation, has resulted in a successful approach using radiation and chemotherapy prior to surgery. "Before this innovative treatment became available, these patients had no curative options if the cancer was not operable. Now, liver transplantation gives patients with cancer of the bile ducts a new chance at life," says Dr. Brown.
While non-alcoholic fatty liver disease is clearly on the rise, undetected viral hepatitis C infection accounts for about 50% of the center's patients with chronic liver disease. Acquired through sharing needles, blood transmission, sexual transmission, transfusions prior to 1991, and other sources, the danger in hepatitis C results from the scarring it causes in the liver. "People don't die from the hepatitis C virus they die from the complications it causes," says Dr. Brown. Medical treatment is available and effective in many patients, but the majority don't come to medical attention until the disease is advanced, he explains. "Symptoms of hepatitis C, such as fatigue and pain, are non-specific and don't necessarily point to a liver problem," he says. "Unless it is found on a routine screening, most people with hepatitis C don't know they have a problem until very late." Hepatitis C is a contributing factor in the majority of cases of liver cancer treated at the center.
Alcoholism accounts for the next largest group of patients at the center. The Center for Liver Disease and Transplantation is noted for its comprehensive, multidisciplinary treatment program that promotes abstinence and provides strong psychosocial support while treating patients with liver disease. Patients undergo very careful observation during a six-month period, and eligible patients may eventually go on to receive a liver transplant. Compared to the national average of 30% recidivism, only 10% of patients at this program return to drinking. "If a patient is going to have a liver transplant, we need to be certain in advance that we can prevent recidivism. We are very proud of our skill in selecting and treating transplant patients, because this maximizes their chance of success," says Dr. Brown.
Other causes of chronic liver failure include a host of autoimmune diseases, in which the immune system attacks the liver or bile ducts of the liver, and less common diseases such as Wilson's disease, Alpha 1 antitrypsin deficiency, and polycystic liver disease. A significant number of adults have cryptogenic liver disease, in which they develop chronic liver disease for unknown reasons.
The most important thing is to detect liver disease at the earliest stage possible. "Liver disease can affect anybody. The only way to find it when it is treatable is to check for it early, and to prevent the need for transplantation," says Dr. Brown.
Visit the Center for Liver Disease and Transplantation web site.