By Stephen Harrison, M.D.
In 2012, three-quarters of chronic hepatitis C virus (HCV) infections occurred among people born from 1945 through 1965. The most common causes of chronic liver disease are nonalcoholic fatty liver disease (NAFLD), hepatitis and other viruses, and alcohol abuse. As baby boomers age, it has become important to identify those with long-duration chronic disease who are at risk for the most advanced forms of liver disease, includingNAFLD)—the accumulation of excess fat in the liver of people who drink little or no alcohol— and its more severe form nonalcoholic steatohepatitis (NASH).
Given the significant impact of advanced liver disease on health and quality of life for older Americans, as well as the cost of care, geriatricians should seek innovative ways to identify liver disease earlier to provide effective interventions that prevent disease progression for these asymptomatic, but preventable, diseases.
Nearly one-third of Americans have asymptomatic liver disease, also known as fatty liver disease (FLD), approximately 85 million Americans have NAFLD, and 20% have NASH. Liver disease often leads to developing other issues, such as advanced fibrosis, increased risk of cardiovascular events and, in extreme cases, liver cancer, liver transplantation and death.
Given the significant impact of advanced liver disease on health and quality of life for older Americans, as well as the cost of care, geriatricians should seek innovative ways to identify liver disease earlier to provide effective interventions that prevent disease progression for these asymptomatic, but preventable, diseases.
Liver Disease and HCV Connection
More than one-third of HCV-infected individuals progress to advanced fibrosis and cirrhosis, and among those with cirrhosis, about 3 – 5% per year develop decompensated cirrhosis and/or hepatocellular carcinoma (HCC).
One study on how NAFLD impacts patients treated and cured for HCV found that NAFLD identified in patients prior to treatment persisted after curing their HCV infection. Among those with NAFLD before treatment, 6.25% still had significant liver scarring after their HCV infection was cured.
Geriatric clinicians can play an important role in educating patients about the hidden epidemic of HCV and encourage at-risk individuals to get tested for HCV and liver disease.
Prevention and Treatment
Fortunately, NAFLD can be reversible if caught in the early stages. Research suggests that weight management is the best approach to controlling or reversing NAFLD. Even a loss of 3-5% can improve liver health. Also, exercise and diet therapy for the elderly can reduce the fat accumulation in the liver and improve hyperlipidemia, hypertension and insulin resistance.
The American Diabetes Association has recommended the evaluation of comorbidities that may impact management like NAFLD. For elderly patients, the identification of advanced fibrosis and cirrhosis is essential for risk factor reductions, medical management and improvement in daily activities and quality of life.
Liver Health Exam at the Point of Care
When it comes to addressing HCV and liver disease, geriatric clinicians should take a “whole person” approach to patient engagement and support behavioral changes that will lead to better outcomes and higher quality of life.
VCTE tools, such as FibroScan, a non-invasive, painless and quick examination, is a medical non-imaging modality that quantifies the stiffness of liver tissue. Rapid results and test scores on these non-invasive screening tools are extremely helpful in providing additional information for geriatric clinicians, empowering them with data and information they can use in real time to refer patients to a specialist or recommend changes to their overall care plans, if needed. VCTE tools are covered by Medicare, Medicaid and many insurance plans, and can be operated by a medical assistant for immediate interpretation by a healthcare professional.
The most effective non-invasive liver exam tools are highly mobile, can be operated by a medical assistant and interpreted by the healthcare professional. They produce numeric measurements, rather than images, for simplified interpretation and consistency of measurement. This enables clinicians to monitor changes in liver tissue over time. In fact, experts anticipate that such rapid tools that provide consistent liver measurements will be performed as a routine part of care management.
Author: Stephen Harrison, M.D., Gastroenterologist and Hepatologist, Medical Director of Pinnacle Clinical Research, and Visiting Professor of Hepatology, University of Oxford
