Einstein/Montefiore Department of Medicine

AASLD Debriefing

Liver Disease Mortality High, But Research is Promising

Image: Allan Wolkoff, MD

Allan W. Wolkoff, MD

Presentations at this year’s American Association for the Study of Liver Diseases annual meeting in Boston included findings that chronic liver disease and cirrhosis, estimated by the Centers for Disease Control and Prevention (CDC) as the country's 12th most common cause of death in adults, may actually rank as high as 4th on the list.

Conditions such as hepatitis C and fatty liver disease, precursors to more serious conditions like cirrhosis (scarring), liver cancer, and the need for transplantation, are rampant in the patients we see here in the Bronx.

Hepatitis C is a viral infection that causes inflammation of the liver. Left untreated, hepatitis C can lead to cirrhosis, decline in liver function, and, in some cases, liver cancer and the need for transplantation. Many people with hepatitis C don’t even know they have it. Someone can have hepatitis C for 30 or 40 years before it starts causing major liver problems. We see many patients who contracted hepatitis C years ago, perhaps through a blood transfusion before transfusions were tested, by getting a tattoo, or by experimenting with drugs with a needle, even just once in their teenage years—just one time will do it.

The people who are really sick with hepatitis C are the tip of the iceberg, but then there’s the rest of the iceberg under water, because before you can treat a disease, you need to know that you have it. Undiagnosed, hepatitis C virus (HCV) replicates and can damage the liver. The increasing incidence of liver cancer is prevalent in people with longstanding hepatitis C.

Even those with a slight risk of hepatitis C should be tested for the virus, because detecting and treating this disease greatly reduces the risk of developing severe conditions like liver cancer and cirrhosis. Blood tests that check for HCV antibodies, that assess liver function, and that check for liver inflammation are commonly used diagnostic methods for hepatitis C.

The good news is that hepatitis C is treatable. Once diagnosed, a 6-to-12-month regimen of antiviral medications, taken daily by mouth or weekly by injection, can often suppress the hepatitis C virus (HCV) for long periods of time. Some effective new treatments about to be released are quite promising: boceprevir and telaprevir, agents known as protease inhibitors because of the way they directly target and suppress the virus, are thought to increase the cure rate up to 75% when added to current treatment regimens. We are waiting expectantly for these drugs to be released and look forward to offering our Bronx community these state-of-the-art treatments.

Fatty liver disease is also endemic in both our pediatric and adult Bronx residents. This disease is characterized by inflammation caused by fat buildup in the liver, and can also lead to cirrhosis. Fatty liver disease is often related to obesity and diabetes, both of which are widespread health problems in our community.

As in hepatitis C, many people with fatty liver disease remain asymptomatic for years, but unlike hepatitis C, fatty liver disease is more difficult to diagnose and treat. Imaging tests such as abdominal ultrasound or MRI can detect fat buildup in the liver cells. Some evidence shows that losing weight, lowering cholesterol, and controlling diabetes can delay the damage caused by fatty liver disease.

Our Montefiore-Einstein Liver Center currently provides integrated care for patients with liver disease, with hepatologists, oncologists, surgeons, radiologists, psychiatrists, pediatric gastroenterologists, and family medicine practitioners all in one place. We offer patients and their referring doctors a unified model for all types of liver problems, including surgical issues, medical management, liver transplantation, liver oncology and pediatric liver disease. We are in the process of building onto our clinical care system by setting up a multidisciplinary center to include hepatology and nutrition, bariatric surgery, endocrinology, and diabetology.

More than ever before, liver disease research is teeming with exciting discoveries, including stem cell transplantation and gene therapy. While still in the experimental stage, we are hoping for their eventual success use in our patients.

By continuing to offer our patients access to state-of-the-art treatment, including advanced clinical trials and novel therapeutic approaches to complex liver problems, and expanding our clinical coverage into new areas to fully integrate care, we are furthering our mission to improve the health of people who live in the Bronx, and we are providing a successful treatment model for the rest of the nation and the world to follow.

Dr. Wolkoff is Professor of Medicine and of Anatomy & Structural Biology, Chief of the Division of Gastroenterology and Liver Diseases, Associate Chair for Research for the Department of Medicine at Albert Einstein College of Medicine/Montefiore Medical Center, and Chairman of the Board of the American Liver Foundation. 

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