The largest internal organ in the human body, liver is not just a digestive organ; it plays a major role in various metabolic processes, complex manufacturing of proteins, hormones, and excretory function.
There has been an increase in the prevalence of liver diseases in the last two decades. In India, nearly 2 lakh die of liver disease every year while 10 lakh people are getting diagnosed with liver cirrhosis.
Among the population in Kerala, the prevalence of liver diseases is higher with at least 300 patients undergoing expensive treatments like liver transplantation.
In the last couple of decades, the rate of metabolic disorders such as hypercholesterolemia, diabetes and hypertension has been increasing. The major reasons are sedentary lifestyle and changes in eating habits. Over eating and alcohol consumption have adversely impacted the liver and digestive health of the people.
Why liver diseases are known as silent killers?
Whatever be the cause of liver disease, whether alcohol or Nonalcoholic Fatty liver disease (NAFLD), viruses or genetic reasons, the progression happens in a particular manner. Initially fat accumulates (steatosis), followed by inflammation of liver cells (hepatitis) and finally scarring of tissues (fibrosis). Advanced fibrosis results in cirrhosis.
The different stages of the progression of the disease, which will occur in 20 to 30 years, to reach the stage of cirrhosis is silent. Usually, the patient doesn’t have any symptoms even when significant changes are happening to the tissues in the liver. The symptoms will surface only when the conditions worsens to the final stage. The silent phase is the golden window of opportunity to treat and recover fully before permanent damage happens in the forms of cirrhosis or liver cancer.
The silent phase of liver diseases is the time to get treated and cured. During the symptomatic phase of the disease permanent damage will happen to the liver. The good news is that the liver can completely reverse the condition and regain normal health through timey intervention and treatment. The real challenge is to diagnose the disease at its silent phase. This is where screening is crucial.
Screening for liver diseases: When and how?
Two decades ago, the average age of patients with chronic liver disease and cirrhosis was 50 or 60. Now, patients in their 40s undergoing liver transplant is not that uncommon. Liver disease screening, after the age of 40 would be an ideal goal, especially for those with risk factors such as regular alcohol consumption, over weight/ obesity, diabetes, high cholesterol, hypertension and those with family history of chronic liver disease.
Most patients go by a combination of the blood test – LFT and liver ultrasonogram (USG). But this test fails to detect pre-cirrhosis in its silent phase.
1. Fibroscan- This is a painless scanning. Fibroscan gives semi-quantitative assessment of scarring/ fibrosis (which is pre-runner of cirrhosis) as well as quantification of fat in the liver. This assesses liver stiffness by passing ultrasonic waves into liver substance. Fibroscan assesses pre-cirrhosis in its silent phase.
2. Ultrasonogram: This gives a rough estimate of fat in the liver. It can detect cirrhosis when it is full-fledged. But silent pre-cirrhosis is rarely detected; hence Ultrasonogram is not an ideal stand-alone screening technique.
3. Blood tests: LFT and Platelet count. With progression of scarring/ fibrosis in the liver, platelet count dips over the years. This is a simple technique of assessing silent cirrhosis. The formulae based on platelet count, viz, APRI, FIB 4 are also used to assess pre-cirrhosis and liver scarring.
Economic perspective of liver disease screening
Chronic Liver disease, after it reaches the stage of cirrhosis or liver cancer translates into high health care expenditure. Liver transplant and treatment modalities of cancer are quite expensive. If chronic liver disease is detected at its silent phase through screening, restoring normalcy is possible. The expense for screening and the treatment is quite less, mostly involving lifestyle modifications, treatment of liver directed viruses or rarely treatment of genetic disease which causes iron/ copper over load.
In summary, detection of the silent phase of liver diseases through screening techniques not only averts permanent damage to the liver, but also helps reduce overall health care expenses.
