Expert lists the most common liver diseases in India | Health Conditions News

Over the years, the number of patients succumbing to chronic liver disease/cirrhosis has increased despite improvements in healthcare. Liver diseases are not only responsible for mortality, but also for a significant proportion of disability-related life years (DALYs).

The importance of promoting liver health through conscientious lifestyle choices should not be overlooked. (Image: Freepik)

New Delhi: Liver disease is the fourteenth most common cause of death among humans. Over the years, the number of patients succumbing to chronic liver disease/cirrhosis has increased despite improvements in healthcare. Liver diseases are not only responsible for mortality, but also for a significant proportion of disability-related life years (DALYs).

Dr. Dharmesh Kapoor, Consultant Hepatologist, Yashoda Hospitals Hyderabad, said, “The other important thing to remember is that young people (< 45 years) and men (breadwinners) are often affected by severe liver diseases.
Broadly speaking, liver diseases can be divided into two phases. Compensated (when the liver is scarred and the parenchyma is damaged, but liver function tests remain normal/near normal) and decompensated (the liver is both scarred and functionally compromised).

He explained: “The number of compensated cirrhosis patients exceeds the number of patients with decompensation in the ratio 10:1. Finally, liver diseases are burning a big hole when it comes to healthcare utilization. Patients with advanced liver disease often require hospitalization and monitoring for the consequences of cirrhosis, such as liver cancer (HCC).

Most common liver diseases

Virus-related chronic liver diseases: Major causes in this category are the hepatitis B virus (HBV) and the hepatitis C virus (HCV). Both causes are responsible for approximately one third of cirrhosis cases in our country.

There is an effective treatment available against both drugs:
• Nucleoside/nucleotide agents against HBV.
• Direct-acting antivirals (DAAs) against HCV.

“With these agents, virus suppression can be achieved in 90-95 percent of cases. These two viruses are also responsible for a significant burden of liver cancer in our country. Therefore, patients must be under constant surveillance for this unique (yet catastrophic) complication of cirrhosis – HCC. Surveillance is generally done through 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 disorders and associated liver diseases (alcoholic hepatitis, alcoholic cirrhosis with decompensation) has increased. Some of these patients exhibit a unique syndrome (acute-on-chronic liver failure, ACLF). ACLF patients become very sick very quickly and may need an emergency liver transplant. In most parts of the world, cirrhosis associated with alcohol consumption accounts for 25 to 30 percent of hospital admissions to liver disease wards.

Unfortunately, there are no specific medications available to treat this condition other than abstinence and nutritional rehabilitation. Emphasis should also be placed on the neuropsychological component of this disease to improve abstinence rates.

Metabolic dysfunction-associated steatotic liver disease (MASLD): This is the new nomenclature for what was previously called NAFLD (non-alcoholic fatty liver disease). Due to its association with metabolic disorders (type 2 diabetes, hypertension, dyslipidemia, anthropometric changes, inflamed systemic and cardiac environments), this disease intersects with specialist care (endocrinology, nephrology, cardiology to name a few).

Dr. Kapoor said: “The number of subjects/patients with MASLD has been steadily growing (1 in 3 in the general population has excess liver fat and 7-10% of these subjects may have liver inflammation/scarring). This disease has significant overlap (and bidirectional 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 cause liver cancer (HCC) in subjects even in the absence of cirrhosis, making surveillance challenging.”

In addition to these etiologies of this chronic liver disease, autoimmune liver diseases, metabolic chronic liver diseases, and drug-induced liver damage leading to chronic sequelae are also seen in clinical practice.

Strategies to reduce the risk of liver disease

The important step towards easing the burden of liver diseases are:
• Vaccination (if available): e.g.; HBV. There are some vaccines available on the market that can help prevent the risk of serious liver diseases, especially those caused by viruses.

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

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

• Early referral and link to care or specialist consultation.