Expert lists most common liver diseases in India

Expert lists most common liver diseases in India

Over the years, the number of patients who succumb to chronic liver disease/cirrhosis has been increasing inspite of improvements in health care delivery. Liver diseases account not only for the mortality, but also disability associated life years (DALYs) in a significant manner.

The significance of nurturing liver health through conscientious lifestyle choices must not be overlooked. (Image: Freepik)

New Delhi: Liver diseases account for the fourteenth commonest cause of mortality amongst humans. Over the years, the number of patients who succumb to chronic liver disease/cirrhosis has been increasing inspite of improvements in health care delivery. Liver diseases account not only for the mortality, but also disability associated life years (DALYs) in a significant manner.

Dr Dharmesh Kapoor, Consultant Hepatologist, Yashoda Hospitals Hyderabad, said, “The other important thing to remember is than young (< 45 years) and males (bread-winners) are commonly affected by serious liver diseases.

Broadly speaking, liver diseases can be categorised into two stages. Compensated (when the liver is scarred and parenchyma is damaged, but tests of liver function remain normal/near normal), and decompensated (liver is scarred as well as functionally compromised).

He explained, “The compensated cirrhosis patients outnumber those with decompensation in the ratio 10:1. Lastly, the liver diseases burn a big hole when it comes to health care utilization. Patients with advanced liver disease frequently need hospitalization and are required to be under surveillance for sequelae to cirrhosis like liver cancer (HCC).”

Most common liver diseases

Virus related Chronic Liver Diseases: In this category, important causes are hepatitis B virus (HBV) and Hepatitis C virus (HCV). Both these two causes account for about a third of cases of cirrhosis in our country.

Effective treatment is available against both of these agents:

• Nucleoside/Nucleotide agents against HBV.

• Directly acting antivirals (DAAs) against HCV.

“With these agents, viral suppression can be effected in 90-95 per cent cases. These two viruses also account for a significant burden of liver cancer in our country. Hence, patients need to be under constant surveillance for this unique (but catastrophic) complication of cirrhosis – HCC. Surveillance is commonly done by means of scanning (US, CT, MRI) and tumor markers (AFP/PIVKA II/Composite scores),” the expert said.

Alcohol use related Chronic Liver Disease: The number of patients suffering from alcohol use disorder and associated liver diseases (alcoholic hepatitis, alcoholic cirrhosis with decompensation) has been on the rise. A proportion of these patients present with a unique syndrome (acute-on-chronic liver failure, ACLF) ACLF patients become very sick, very quickly and may need emergency liver transplantation. In most parts of the world alcohol use disorder associated cirrhosis accounts for 25 – 30 per cent of hospital admissions to liver disease wards.

Unfortunately, no specific drugs are available to treat this condition except abstinence and nutritional rehabilitation. Emphasis should also be paid to the neuropsychological component of this illness to improve abstinence rates.

Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD): This is the new nomenclature for what was earlier called NAFLD (non-alcoholic fatty liver disease). This disease because of its association with metabolic derangements (type 2 diabetes, hypertension, dyslipidemia, anthropometric changes, inflamed systemic and cardiac millieu) cuts across specialties of care (Endocrinology, Nephrology, Cardiology to name a few).

Dr Kapoor said, “The number of subjects/patients having MASLD has been steadily growing (1 out of 3 in general population have excess liver fat and 7-10 % of these subjects may have liver inflammation/scar tissue). This disease has significant overlap (and two way synergy) with obesity and type 2 diabetes. The mainstay of therapy is weight loss – either through lifestyle modification or pharmacotherapy/bariatric surgery. This disease has a unique propensity to produce liver cancer (HCC) in subjects even in the absence of cirrhosis, which makes surveillance challenging.”

Apart from these etiologies of this chronic liver disease, autoimmune liver diseases, metabolic chronic liver diseases, drug induced liver injury leading to chronic sequelae are also seen in clinical practice.

Strategies to mitigate risk of liver disease

The important step towards mitigating the burden of liver disease are:

• Vaccination (when available ): eg; HBV. There are a few vaccine available in the market that can help prevent the risk of severe liver disease, especially those induced by virus.

• Healthy lifestyle: This includes eating habits, regular exercise, weight control and abstinence of alcohol.

• Screening for high risk groups: Diabetes, obesity, family history of liver cancer etc increase the risk for liver disease. Hence, it is better to get detected early so that these conditions can be treated effectively.

• Early referral and linkage to care or specialist consultation.