Trends in Liver Disorders & Eradicating Hepatitis C

Good afternoon, this is Dr Kieron Lim - a Senior Consultant in Gastroenterology and Hepatology at the Mount Elizabeth Hospital in Singapore.

The most striking trend in liver disease over the last 5 to 10 years is the decline in Hepatitis C, which is largely attributed by the very potent and effective medications that came online around 2010. This has drastically reduced the incidence of Hepatitis C around the world.

As Hepatitis C falls, the incidence of fatty liver disease is steadily climbing. This trend has been seen globally in Western countries and Asia.

Liver cirrhosis is the end stage of liver disease, characterised by the significant scar tissue forming in the liver. There are many reasons and causes for this to happen. The three common causes include viral hepatitis, especially Hepatitis B and C. As mentioned earlier, Hepatitis C is largely not a problem anymore due to the very efficacious and effective medications that are available on the market. Other causes of liver cirrhosis include alcohol, but the fastest rising single cause is fatty liver disease.

The complications of liver cirrhosis include jaundice (a yellowish discolouration of the eyes and the skin), ascites (the accumulation of fluid in the abdominal cavity), varices, blood vessels that can enlarge and form the oesophagus in the food pipe as well as in the stomach. These can potentially rupture and bleed and cause internal haemorrhage.

Another complication commonly encountered is hepatic encephalopathy - a medical term for liver patients being confused. This is also a spectrum from mild concentration, poor concentration, mild sleep disturbance and deep coma. It occurs because the liver is unable to excrete the toxins from the body efficiently, resulting in a build-up of ammonia which crosses into the brain.

Another complication that is often feared is the development of primary liver cancer or hepatocellular carcinoma. When these complications arise, the patient should be urgently referred for consideration and evaluated for a liver transplant. The greatest advancement is the discovery of potent antiviral medications. I alluded to this earlier which means hepatitis C is significantly decreasing and some countries like Australia, are looking to eradicate hepatitis C.

There's extensive research undergoing now to try and combat fatty liver disease. There are many clinical trials undergoing at present. Hopefully in the near future, we will have a medication available to us as effective as the hepatitis C medications which can reverse and cure patients with fatty liver disease. This will be a multidisciplinary programme comprising and helmed by experienced specialists to look after the transplant patient and donor in a holistic way.

The core group of specialists includes the liver surgeon, hepatologist, intensive care specialists, infectious diseases specialists, a multitude of specialist nurses and allied health professionals. One of the key challenges in Singapore is the low cadaveric donation rates. This is something which many Asian countries are experiencing, also the reason and motivation why living donor liver transplant has been developed and successfully carried out in various parts of the world.

We also offer living donor liver transplants for our patients. What's unique in Singapore is that on a case-by-case basis, the potential donor can also be an emotionally related donor. Typically, donors are next of kin and family members. However, when certain conditions are not met and potential family members are not suitable for donating their livers, individuals with a very strong emotional relationship, for example old childhood friends and close colleagues can be considered for liver donation for the liver transplant recipient.

Over the last 50 years, liver transplantation has advanced in leaps and bounds. When transplantation was first offered as a treatment option, the one-year survival rate was close to 30%, meaning 70% of patients were not alive one year after the transplant. Fast forward to the present day, the one-year survival is approaching 85-90%. Thus, with better surgical techniques, better intensive care, better medications, transplant patients are living better and longer.

My advice to doctors that are seeing patients with liver disease is to refer patients with cirrhosis, especially decompensated cirrhosis with complications to a liver transplant center for early evaluation. For patients, I urge you to follow-up regularly with your physician, be sensitive to new symptoms that may arise and to seek medical treatment at an early stage. Early detection is key to initiate treatment, prevent the progression of liver disease, prevent the development of cirrhosis and its complications.

For more information, refer to the article here