The spectrum of chronic liver diseases in the State has been on an upward spiral for a while, thanks to the high levels of alcohol consumption among the population as well as the epidemic of lifestyle diseases.
Liver diseases develop silently, without any signs or symptoms. Damage to the liver progresses gradually and the patient begins to show symptoms only when over 70% of the liver has become dysfunctional.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by varied liver conditions such as hepatitis, chronic alcoholism, and non-alcoholic fatty liver disease (NAFLD). The damage due to cirrhosis generally cannot be undone. But early diagnosis and treatment can limit further damage.
In recent times, there is increased focus in the West on improving the diagnosis and treatment of chronic liver diseases through screening high-risk patients early.
The National Institute for Clinical Excellence and Care (NICE) recommends that men and women drinking alcohol at potentially harmful levels — more than 50 and 35 units a week respectively — be offered a test (transient elastography or Fibroscan) to exclude cirrhosis.
NICE guidelines also calls for all those diagnosed with NAFLD to be regularly tested for advanced liver fibrosis so they can manage their condition and prevent it from developing into cirrhosis. However, even in the West, there is insufficient evidence to support a screening programme for cirrhosis, some experts say.
Currently, there are no recommendations for screening for cirrhosis in Indian population.
“There can be no universal screening programme for liver diseases because it is multi-factorial. Any screening programme should ultimately be simple and cost effective,” says K.R. Vinayakumar, former professor of Gastroenterology, Government Medical College Hospital here.
Approximately 60% of the cirrhotic liver cases in the State are owing to alcohol and viral hepatitis infections while the rest can be attributed to lifestyle diseases.
A universal screening programme for detecting viral hepatitis owing to Hepatitis B and C viruses is plausible and effective. But there can be no large-scale screening programme for other conditions that can lead to cirrhotic liver.
Misnomer
It should also be understood that Liver Function Tests (LFT), which assesses a panel of liver enzymes, have little predictive value when it comes to ascertaining liver health. In fact, the name liver ‘function’ test itself is a misnomer.
Though LFT is used as a first-line investigation for liver diseases, this test gives little indication about the functionality of the liver. These tests primarily assess liver injury rather than liver health. One’s LFT can remain normal despite significant underlying liver fibrosis, hepatitis, or even cirrhosis.
Thus, an abnormal LFT result may often indicate that something is wrong with the liver. But a normal LFT does not always mean that the liver is normal.
Transient elastography or Fibroscan is a fairly recent non-invasive ultrasound test to assess liver damage owing to fibrosis. However, it has reportedly been found to be less accurate in determining the early stages (I and II) of fibrosis.
“In Indian settings, early detection of chronic liver diseases has to take place through the clinical assessment of individuals and the risk factors — virus positivity, alcohol, and obesity — factored in. The lack of epidemiological data is affecting our treatment plans,” Dr. Vinayakumar says.
C. Maya
