Hepatologist Pere Ginès: “As drinking doesn’t stop and obesity doesn’t stop, cirrhosis and liver cancer will increase” | Health & Wellness

The liver doesn’t hurt or complain when it suffers. At least not at first. Chronic liver disease develops silently for years without symptoms or warning signs, and progresses quietly under the auspices of dangerous alcohol consumption, hepatitis virus infection, or fatty liver disease (associated with obesity and overweight). Chronic liver disease develops only at a more advanced stage, when cirrhosis or liver cancer has already plagued the tired liver.

Early detection of the disease is an unresolved task for the scientific community, which does not have powerful tools to diagnose it at an early stage. so far.A study published in Lancet A scale has now been validated that stratifies risk and identifies apparently healthy individuals from the general population who are at risk for severe liver disease in the future. Pere Ginès, Consultant at the Hospital’s Clinical Liver Service and Head of the Chronic Liver Disease Group at IDIBAPS, is the coordinator of the index, which measures eight variables: “We have worked hard to make the index easy to calculate, affordable and suitable for all healthy people. It consists of eight Variables: age, sex, and six analysis variables that are traditionally analyzed at the time of examination of a person.” Warning of the growing prevalence of severe liver disease cases, the hepatologist (Girona, 66) is eager to This tool becomes an early detector and a hub for population screening for these diseases.

ask. Is chronic liver disease completely silent?

answer. It has no symptoms. zero. Therefore, it is very important to detect it as early as possible through some effective measures (such as this scale). The patient develops cirrhosis, and the disease progresses until the cirrhosis becomes complicated, which is when the patient develops symptoms. But of course, the disease had been quietly happening in his liver for 25 years, and because we didn’t have the right tools, we couldn’t detect it.

ask. What’s going on inside the liver during the 25 years that the disease has been quietly developing?

R. What happened was that something hurt the liver. This stuff varies a lot, but the most common is the hepatitis virus, which specifically causes liver infection; the other main reason is drinking, and the amount of drinking doesn’t have to be particularly large, but it’s within what many people think is normal drinking, but if it continues Alcohol, which damages the liver; another major cause, and by far the most common, is associated with obesity, overweight and diabetes, as this leads to the accumulation of fat in the liver – a normal liver has no fat – and this fat, associated with excessive related to fat. Over time, it creates inflammation in the liver. In some patients, this inflammation leads to the deposition of scars, which act like wounds in the liver, and this is what we call fibrosis. In this case, the liver loses its elasticity, becomes stiff, stiff, and everything changes, leading to cirrhosis. This would be the progression from fatty liver and inflammation to scarring, cirrhosis and later liver cancer.

ask. This is the case for obesity and overweight, but does the case for alcohol or hepatitis follow the same pattern?

R. The pattern is similar for alcohol, since dangerous drinking also leads to fat deposits in the liver. In a viral infection, the situation is different because there is no fat, but the virus damages the liver cells, and this damage causes inflammation. This chronic inflammation also causes scarring and may lead to cirrhosis of the liver.

ask. Is cirrhosis always the last stop in the evolution of the disease?

R. Cirrhosis is pretty much the last stop, but it also has several stages. The first one was also silent. Cirrhosis continues to progress as the disease progresses because the factors that damage the liver do not go away. At some point, the liver becomes so disorganized that the cells stop working properly, blood flow becomes difficult, and an increase in blood pressure develops inside the liver — portal hypertension — which is what causes most diseases. A serious complication of cirrhosis. Since cirrhosis is a precancerous condition, over time some of these patients develop liver cancer.

ask. Is the liver grateful? Is it more resilient than other organs?

R. This is true to a certain extent. A grateful liver is a healthy liver. If a person is in a traffic accident and part of their liver ruptures, they’ll have surgery, the damaged part is removed, and after a month and a half, they’ll have a normal liver again because it will grow back and go back to a normal liver. Same volume. A diseased liver cannot do this, but what it can do is that the sooner liver disease is detected, the more likely it is that these scars will go away, or at least stop their progression, by eliminating the cause. The more advanced the disease, the less likely it is to reverse, but progression can be stopped. This is important to us because people die from disease progression.

ask. How has the patient’s condition changed regarding the precursors to chronic liver disease? For example, patients with hepatitis C can now be cured with a new generation of antiviral drugs.

R. Profiles have changed a lot. Fifteen years ago, more than 50% of people we diagnosed with advanced chronic liver disease and cirrhosis had hepatitis C. or hepatitis C with dangerous drinking. Hepatitis C is now reduced to a minimum. The main current cause is metabolic fatty liver, which is associated with overweight and obesity. This will continue to increase in the future: all projections point to a sharp increase in severe liver disease due to metabolic fatty liver disease.

ask. Regarding obesity and being overweight, studies have shown that eating fast food is more likely to cause liver cirrhosis than drinking alcohol. Do you think the public understands this situation?

R. I don’t think he’s conscious at all. This was proven 30 years ago. The poorer the food variety and the more sedentary your life, the earlier cirrhosis will occur. For example, in the US they started diagnosing teenage cirrhosis a few years ago: teens eating poorly, eating fast food, lots of carbs, lots of fat, little veggies, not exercising…well, they make a lot of weight up to 15, 17, At the age of 20, he already had cirrhosis of the liver.

ask. Is it possible for teenagers to develop cirrhosis?

R. Yes. In fact, when we now diagnose obese or overweight people with cirrhosis, when we ask them when they started gaining weight, most start at age 30 or 35, with onset at age 60: 25 years on , or your liver has been under constant stress for 30 years. But if that stress is more intense, if the life is more sedentary, as many children and adolescents do, and the intensity of eating poor quality and quantity is higher, in addition, there is another risk factor, such as alcohol consumption, The risk of liver disease rises dramatically. They’ve started to see the same in the US and the UK, and we’ll see it here soon: the age at which cirrhosis is diagnosed for metabolic reasons, which is now around 60, will gradually decrease.

The age at which cirrhosis is diagnosed for metabolic reasons, which is now about 60, will gradually decrease”

ask. People may associate cirrhosis more with alcohol and severe drinking problems. But you said that excessive consumption does not necessarily damage the liver.

R. Most of the alcoholic cirrhosis patients we diagnose have never consumed alcohol in their lives. Of course, you can drink enough alcohol without getting drunk. Drunkenness refers to the acute effects of alcohol on the central nervous system and brain. But the chronic effects affect other organs, and the liver is the worst affected: after a few minutes, everything you drink goes to the liver. Therefore, the amount that has been thought to increase the risk of chronic liver disease is relatively low: 14 to 21 units (one drinking unit is a glass of wine or one-fifth) for men. So people who drink two-fifths or one glass of wine a day or one-fifth already have an increased risk compared to those who don’t drink, a small percentage of whom end up with liver disease. The more you drink, the greater the risk. Also, even more so if you are obese or diabetic. Women were more sensitive to the toxic effects of alcohol on the liver, with a dangerous amount of seven units per week.

ask. What are the treatment alternatives for chronic liver disease?

R. We have three: one is to remove the pathogen, which is very effective if done, especially if done early on; Complete, that is, transplantation. With these goals of early detection of liver disease, what we want to achieve is not requiring the use of transplants.

ask. What do you hope to find when this scale enters clinical practice? What are the prospects for the next few years?

R. Over the next few years, all models suggest that the number of liver diseases, including cirrhosis and liver cancer, will increase very significantly, because while hepatitis C has decreased substantially, a major cause, such as alcohol, has not slowed down . Declining, but even increasing with the pandemic, and showing no clear signs of slowing down. Another reason has to do with the obesity epidemic, which is hard to stop.

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