The liver, the silent sufferer
The liver is an organ that rarely complains. In fact, many persons suffering from chronic liver disease are unaware of it. It goes unnoticed and is rarely diagnosed before the first symptoms appear.
The need to find new means for the early detection and treatment of this type of illness is what brings over 10,000 experts from all around the world to the Gran Via site of Fira de Barcelona this April for the congress of the European Association for the Study of the Liver.
In this interview, Dr. Pere Ginès, head of the Hepatology Service of Barcelona’s Hospital Clínico and Senior professor of medicine at the University of Barcelona, gives us some insight into this silent condition.
- What does liver disease mean?
It’s a very broad term which includes any illness that occurs in the liver. The most common conditions are the result of many years of chronic inflammation which could be the result of infection by the hepatitis virus – especially type C and B, metabolic disorders (fat deposits caused by obesity or diabetes), prolonged alcohol consumption or other diseases of the auto-immune system, iron or copper deposits…
The problem with these conditions is that over time they can eventually cause cirrhosis, which then calls for a transplant, or in many cases degenerate into cancer.
- What changes have there been in recent years in relation with these diseases?
There have been two major developments: the appearance of highly effective antiviral drugs for the treatment of hepatitis C, which is very common in our environment (there are over 10,000 people infected with this virus in Catalonia); then there has been a considerable increase in cases of “non-alcohol related liver fat”, which refers to people who accumulate fat in their livers because of serious obesity or because they suffer from diabetes.
Our western societies are seeing these conditions emerge as the second cause of chronic liver disease, and they will soon be the first (which is currently alcoholism or the C virus, depending on the area).
- Risk factors
There is alcoholism, which is not restricted to those with serious addiction to alcohol, but includes those with moderate but prolonged consumption, and who may have never actually been drunk, for example. Another risk factor is the toxicity of some medicines, often related with self-medication, although they cause acute, but not chronic illness.
- What is hepatitis?
It is the inflammation of the liver. The most common and best-known cause is viral (when you turn yellow), especially type B and C. Once infected, the body never completely eliminates them, and they become a chronic condition which can produce significant damage to the liver over the course of 20-30 years.
There is now a vaccine for Hepatitis A and B, which means that there are few new cases (they are only found among immigrant populations). Type C, in contrast, has no vaccine, but we do now have a very effective treatment. The problem with this hepatitis is knowing that you have it, because there are no symptoms, and indications only appear when it is very advanced.
- Liver transplants
Catalonia has a higher number of liver donors than most other European countries and the USA, Canada and Australia. Even so, more donors are needed: to give one example, it is estimated that 170,000 people die every year from hepatic cirrhosis in Europe, and only 5,500 transplants are carried out.
There are many more patients waiting for a transplant than livers available, which means we have a lot of work to do in improving our treatments and applying preventive measures (such as vaccination and reducing the prevalence of obesity in the population, among others).
- How should we take care of our liver?
With a balanced diet, watching your weight (to prevent fat accumulating in the liver) and moderating your drinking. What does that mean? Cutting down on alcohol. Men are considered to be at risk of suffering chronic liver disease by consuming 40 grams of pure alcohol a day for 10 years.
If you have three beers a day, for example, you are over this limit. For women these thresholds are even lower. between 25-30 grams a day, which is two beers. This is why it is important that we explain to the population that alcohol must be taken in moderation.
- Where is current research being directed?
There are three main lines of research: one, to prevent the appearance of hepatic cirrhosis in persons with non-alcohol-related liver fat ; the second is to find early indicators of alcoholism; the third is to prevent chronic liver disease degenerating into cancer, cases which have increased considerably in recent years and which are unfortunately difficult to diagnose and treat.
The most important thing is the early detection of chronic liver disease sufferers – because there are many who are unaware of it, it is silent and goes unnoticed until it is very advanced – to eliminate the cause of it and stabilise it so that it does not progress further: stop drinking, lose weight… New tests are being researched at the moment, which are simpler and can be included in routine check ups like the ones for detecting sugar or cardiovascular disease, that will enable us to tell us what is happening to our livers while it is in the early stages.