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Liver disease is becoming more prevalent in the U.S. Hepatitis A, B, and C are leading causes of liver disease, but rarer disorders, such as Wilson’s Disease and NASH require life-long attention.

The liver, the body’s largest organ, is also one its best “multi-taskers.” Among its many functions, the liver stores, metabolizes, and releases nutrients; aids in the digestive process; and removes harmful substances, such as drugs, from the blood.

And while the liver can regenerate, it is not indestructible. Authors of the National Institutes of Health’s Action Plan for Liver Disease Research report estimate that 1 of 4 Americans will have a disease of the liver or its related biliary system in their lifetime. Not all of these diseases will lead to a need for liver transplant (fortunately so, with more than 17,000 people waiting for a new liver), but they can take a significant toll on a person’s ability to work and quality of life. Physical symptoms such as fatigue, fluid retention, muscle weakness, and nausea, sometimes coupled with psychosocial problems such as depression, can make chronic liver disease a difficult foe.

The Harm of Hepatitis

Inherited conditions, excessive alcohol, exposure to industrial solvents, and even too much acetaminophen, an ingredient in over-the-counter pain medications and other drugs, can lead to chronic or acute liver disease. But of all the causes of liver disease, hepatitis is the most common.

“Hepatitis” refers to an inflammation of the liver, and there are five distinct hepatitis viruses that have been identified in humans. They are identified by letters of the alphabet. Four to six million Americans have been exposed to hepatitis C, the leading indication for liver transplantation (see “A Test That’s Worth Taking”), but it is not the only form of hepatitis that causes concern. Ten to 15 percent of those exposed will develop cirrhosis and are also at increased risk for liver cancer.

Hepatitis A is an acute disease that is typically transmitted via contaminated water or food. It is relatively uncommon in the United States, but international travelers (particularly those headed for developing countries or places with poor sanitation systems) are encouraged to be vaccinated against the hepatitis A virus.

Hepatitis B was once a major public health threat in the United States—and it still is in some parts of the world, such as Asia and the Pacific. While the hepatitis B vaccine has become a valuable tool against the virus, those people who are currently infected or are not vaccinated and contract the hepatitis B can face serious health problems, including the need for a liver transplant or even death. In the United States, 1.25 million people have chronic hepatitis B, and there are 5,000 to 6,000 hepatitis-B related deaths each year. Chronic hepatitis B also dramatically increases the risk of liver cancer. Fortunately, the hepatitis B virus, which is transmitted via blood and bodily fluids, causes chronic infection in fewer than five percent of the cases. As for the other types of hepatitis, Hepatitis D and Hepatitis E rarely occur in the United States.

Other Liver Problems

Although the epidemic of hepatitis C has generated tremendous concern among liver specialists, there are many other liver diseases that might never lead to a transplant, but need to be treated for patients to have the best chance at a healthy life.

Take Wilson’s disease, for example. It is an inherited, recessive condition in which the body is unable to rid itself of copper, leading to a build-up of the mineral in key organs such as the liver and the brain. Over time, too much copper in the liver can lead to symptoms such as jaundice and swelling of the abdomen and, untreated, lead to acute liver failure, a need for liver transplantation, or death.

Fortunately, Wilson’s is both rare and treatable. Many patients, when diagnosed early on, respond well to the drugs that help remove copper from the bloodstream. And while a lifetime of medication might seem daunting to the young patients in which Wilson’s is typically diagnosed, it is better than the irreversible damage the disease can bring.

Some liver diseases are linked to irregularities with a person’s immune system. One of them, autoimmune hepatitis, primarily affects women and starts as early as adolescence. As the name suggests, autoimmune hepatitis can cause inflammation of the liver and other symptoms common to liver disease—such as jaundice and itching—as well as some associated with autoimmune disorders, namely, aching joints. Fatigue, common to both, is a frequently reported symptom. Lab tests show the presence of increased gamma globulin and smooth muscle antibodies in the blood.

Many people with autoimmune hepatitis respond well to prednisone treatment, which can relieve symptoms and cause elevated liver enzyme levels to return to normal. As with Wilson’s disease, autoimmune hepatitis is a condition that needs monitoring over the long-term, as it can lead to cirrhosis and ultimately, the need for a liver transplant.

There’s another liver disease, nonalcoholic steatohepatitis, or NASH, that is associated with two major health problems in America today, diabetes and obesity. NASH occurs when there is fat in the liver; causing the liver to become inflamed; and there is damage to the liver. The damage is similar to that which occurs with alcoholic liver disease, but with NASH, the patients have consumed little or no alcohol. Like other liver diseases, NASH is typically “silent” in its early stage, and the first indication often comes from a routine blood test. Elevated liver enzymes indicate to a physician that something is irregular, leading to more tests and elimination of other conditions. It takes a liver biopsy to confirm a diagnosis of NASH; if there is only fat in the liver, but no inflammation or damage, that’s indicative of a different condition, simple fatty liver.

There is currently no treatment for NASH, but studies indicate that by losing weight, getting more exercise, and eating a healthy diet, patients can stop or even reverse the damage caused by NASH.

To arrange for a consultation with University Hospitals liver disease specialists, please call 973-972-7218. To learn more about treatment options for liver diseases, visit our liver transplant website or listen to Dr. Andrew de la Torre's recent appearance on HealthLink Radio.

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