April is the month chosen to spread awareness regarding liver disease and April 19 is celebrated as World Liver Day. Liver disease is increasing and is one of the most common diseases in the world.
Figures by the World Health Organization (WHO) attribute more than 2 lakh deaths in India due to liver disease every year. Nearly 40 per cent of patients in our unit require a liver transplant due to advanced stage of fatty liver disease and nearly a thousand patients may require a liver transplant in Mumbai every year.
Patients with liver disease suffer from many disabling symptoms and also have a high risk of death due to the disease. Patients with liver failure may need a liver transplant to save their lives, which is a very major surgery. Patients needing a transplant also have a very difficult time while waiting for it, until the organ becomes available for their transplant. The risk factors for liver disease and liver failure are changing and differ in various parts of the world and even within our country.
Some of the most common diseases of the liver are:
- Hepatitis A or Hepatitis E infection: These infections are often responsible for the common jaundice in children and adults. These infections are spread by contaminated water and food. It typically resolves in a few weeks but can rarely cause acute liver failure. A vaccine is available for hepatitis A infection, which should be taken by susceptible people.
- Hepatitis B or C infection: These infections are spread by contaminated syringes and needles, untested blood transfusion and unsafe sexual practices. They typically cause liver cirrhosis and liver failure in the long term, over 20 to 30 years. Patients who are diagnosed with these infections at an early stage can be treated with medicines. However, most patients do not have any symptoms of the disease and are unaware of their disease. Most patients are diagnosed at an advanced stage when they may need a liver transplant. Hepatitis B can be prevented with vaccination and is recommended for all children and adults.
- Alcoholic Liver Disease: It is increasing all over the world, including in India, especially in younger people. Depending on the degree of liver damage, the disease may stabilize after stopping alcohol use or progress to liver cirrhosis requiring a liver transplant.
- Fatty Liver Disease: Also called as non-alcoholic steato-hepatitis (NASH), fatty liver disease a life-style disease, and is fast increasing in our country due to increasing obesity and diabetes. If diagnosed at an early stage, it is reversible with the help of following a healthy lifestyle i.e. diet control, regular exercise and control of diabetes. However, the disease is often ignored even when diagnosed at early stages and progresses to the irreversible stage of liver cirrhosis.
Some ways to prevent liver disease are:
- Avoid contaminated water and food, especially during the rainy season
- Vaccination for Hepatitis A
- Practice safe sex using a condom
- Always use disposable needles and syringes for any injections
- Any blood used for transfusion should be checked for Hepatitis B and C infections
- Vaccination for Hepatitis B
- In case of Hepatitis B or C infection, seek treatment early
- Limit alcohol use
- Follow a healthy lifestyle, healthy diet and regular exercise
- Have a good control over diabetes and high cholesterol levels
In the last few decades, due to better hygienic standards, routine testing for hepatitis B and C in blood banks, use of disposable needles and syringes, increasing hepatitis B vaccination and effective treatment for hepatitis B and C, hepatitis is decreasing in our country.
Unfortunately, the incidence of alcoholic liver disease and fatty liver disease is increasing, both of which can be controlled with lifestyle modifications. It is common to find fatty liver on routine ultrasound scans done during health check-up tests in healthy individuals and in donors for liver transplantation. It is also believed that while infective hepatitis (A, B, C, E) are more common in rural areas, alcoholic and fatty liver disease may be more common in urban areas.
Patients with liver cirrhosis are also at a risk of liver cancer (also called as HCC – Hepatocellular cancer). Patients suspected to have liver cancer should undergo a CT scan or MRI of the liver. The cancer may be treated by a liver transplant, liver resection, radio-frequency ablation (RFA) or trans-arterial chemotherapy (TACE).
The author of this article is Dr Ravi Mohanka, Chief Surgeon and Head of Department of Liver Transplant and Surgery at Global Hospital, Mumbai