Millions of Americans have abnormal liver enzymes with the vast majority being due to fatty liver disease and hepatitis C. Fatty liver disease is often caused by excess alcohol intake. For people who do not drink alcohol or drink very small amounts we call their fatty liver disease non-alcoholic steatohepatitis or NASH. With regards to non-alcoholic fatty liver disease, this appears to be an epidemic in our country and is related to obesity, hypercholesterolemia, insulin resistance and diabetes mellitus.
Understanding Liver Disease
In this disorder, the liver cells accumulate excess fat. For the vast majority of patients there is very little inflammation involved and no significant scarring develops. The liver continues to function normally. I often tell patient's that for the vast majority of patients the abnormal liver enzymes makes their doctors worry but really is of no concern. In less than 10% of patients in addition to that deposition of fat in the liver there is significant inflammation and scarring of the liver.
As a hepatologist my primary job is to identify the small percentage of people with Nash who are at risk to develop significant scarring of the liver which can progress to severe scarring a condition we call cirrhosis. Until recently a liver biopsy was necessary to grade the amount of scarring in the liver and the risk of developing cirrhosis. We now have a safe and painless way to avoid a liver biopsy and to identify scarring using a special ultrasound machine called a fibroscan. This test takes a matter of minutes and gives us great information which can accurately predict the amount of scar tissue in the liver. Scarring is graded from a score of F0 meaning absolutely no scar tissue to F4 which means cirrhosis. The scan can also tell us how much fat is in the liver.
Treating Liver Disease
The treatment of fatty liver disease is treatment of high lipid levels, good control of diabetes mellitus and weight loss using a low carbohydrate diet. It is not the fat in the diet that causes fat to be deposited in the liver but rather the amount of carbohydrates we consume in our diet. Limiting carbohydrate means limiting fat deposition. There are many studies now looking for medication which can not only stop the progression of scar tissue but may actually remove scar tissue from the liver. Studies are ongoing at VCU and at the liver Institute of Saint Mary's.
When we evaluate patient with fatty liver and find significant scarring and inflammation we often refer to these 2 institutions for inclusion in these studies. Certainly the treatment of fatty liver disease caused by alcohol ingestion is to stop all alcohol consumption. Our goal is not only to diagnose these patients but also help them find ways to stop drinking.
Understanding Hepatitis C
With regards to hepatitis C. There are approximately 4 million people in the United States with this disease. Certainly we know that intravenous drug use and the sharing of needles is a main cause of infection. Also tattoos where the needle used were not properly sterilized can cause hepatitis C. Transfusion was also a significant cause of hepatitis C in the past but current testing of the blood supply means that the blood is safe from such transmission. With regards to sexual transmission of hepatitis C we think approximately 10% of partners of people infected with hepatitis C will become infected without taking proper precautions such is using condoms. Finally there does not appear to be a serious concern for transmission of the hepatitis C virus from a mother to a newborn child.
Treating Hepatitis C
Approximately 70% of people with hepatitis C will carry the virus for many years. Only 30% of people clear the virus without medication. The good news for patients with hepatitis C is we now have many choices of treatment which are each approximately 95% effective in curing the disease by taking pills for an average of 8-12 weeks. The medications are remarkably well tolerated and effective.
At Richmond Gastroenterology Associates we are happy to provide care for all of those with liver issues.