Earlier commonly caused by Hepatitis B and C, the most common causes of liver disease can now be called alcohol and other obesity related disorders. There has been a paradigm shift in the dynamics of liver cirrhosis and about 10 lakh new patients are diagnosed with it every year in India! Having spoken about the same with Dr Amrish Sahney, Associate Consultant, Gastroenterology and Hepatology, BL Kapur Super Specialty Hospital, here is the lowdown of the conversation with him. What Dr Amrish calls the need of the minute is awareness at the community at large because the next major health concern that the country can be battling is for its liver.
- Around 10 lakh patients of liver cirrhosis are newly diagnosed every year in India.
- Liver disease is the tenth most common cause of death in India as per the World Health Organization.
- Liver disease may affect every one in 5 Indians. - Liver Cirrhosis is the 14th leading cause of deaths in the world and could be the 12th leading cause of deaths in the world by 2020.
- Hepatocellular carcinoma (HCC), or a cancer in the liver, is the second most common cause of death due to malignancy in the world.
Complications with liver cirrhosis
Once the patient is diagnosed as cirrhotic, there are very less chances of reversal of the disease, said Dr Amrish. Cirrhosis is associated with other complications such as ascites (fluid build-up in the abdominal cavity), hepatic encephalopathy, chances of variceal bleeding and other infections. Acting against and controlling all these symptoms can mean a lot of cost expenditure for the patient. As per Dr Amrish, 75 per cent of the patients may not be able to afford this. Once these complications begin, the maximum a patient can survive without a liver transplant is 2 to 3 years.
Dr Amrish said that almost two in every three liver patients show the above symptoms, whereas one in every three is asymptomatic.
Liver demand and supply gap
In north India, 97 per cent of liver transplants are Living Donor Liver transplants, whereas only 3 per cent are cadaver (after brain death) transplants. This is a very meager figure as per Dr Amrish because cadaveric donations offer many advantages over living donations. Cadaveric transplants only need one operation, take less time and offer much better results. He compared it to the other South East Asian countries where cadaveric donations have come up in a big way. The organ donation policy of Singapore is very strict where it is compulsory for most to donate organs after brain death, but for some exceptions. India may or may not implement such stringent laws but something needs to be done to better the situation. One feasible way out is spreading awareness among the students at school level.
Why we must worry
Right now, the major causes of liver cirrhosis are Hepatitis B and C, alcohol abuse and non-alcoholic fatty liver disease in the ratio 3:4:3, as per Dr Amrish. He said that 80 per cent diabetics have more fat than it is healthy and this may lead them to develop non-alcoholic fatty liver disease. The incidence of diabetes and fatty liver disease together is deadly. In the upcoming decade, non-alcoholic fatty liver disease will supersede alcohol as the most common cause of liver damage, he said. Of these, alcohol consumption and non-alcoholic fatty liver disease can be prevented by lifestyle modification. Hepatitis B can also be prevented as its vaccination is now easily available. Even if someone contracts the Hepatitis B or C virus, treatment is now easy and affordable. For Dr Amrish, something needs to be done about liver disease awareness at the community level. Your GPs may not know much about this disease because it is only now becoming more common, also among the young people in India.
Does it affect only old people?
Sadly, no. In fact, it is getting more common in younger people than ever before. Dr Amrish said that liver disease can set in childhood too as it can pass through genes. However, the majority of patients belong to the age group of 40s - 60s.
India versus the West
In India, the age for alcoholic liver disease is coming down and it mostly occurs between the ages of 30 and 40. Whereas, in the West, the average age for the disease has gone up to 45 to 55 years. This is against the popular notion that alcoholism at an early age is more prevalent in the West. Instead, in India, the average age when people start drinking has come down to 16.
Talking about one recent case of a young patient of alcohol related liver disease, Dr Amrish said that the only option he had for survival was transplantation. The 35-year old man had severe arthropathy with bilirubin level at 46 and severe bleeding.
Dr Amrish calls this an epistemological shift that is happening in India and only lifestyle modification is the way out of this nemesis. Prevention
Doing aerobics, having low fat, low sugar and low rice diet, consuming not more than 1400 calories a day and having a high fibre diet are some ways that can keep liver damage at bay, says Dr Amrish. A recent study showed that coffee is good for liver patients. Dr Amrish says that 2 cups of coffee a day can help in slowing progression of liver disease. Another way of preventing liver disease is by staying at your healthy weight. Dr Amrish gives a thumb rule to calculate your ideal weight. Calculate your height in centimetres and subtract 100 from it. The number that you get should be your weight in kilograms.