Liver diseases are generally given less priority than most other non communicable diseases such as, diabetes, heart, hypertension and stroke which are more common and widespread. However, specialists in the field have noted that liver diseases nevertheless pose very significant problems and are a major cause for morbidity and mortality.
Medical student Aslam Fahim who has done a research project on liver diseases in Sri Lanka tells the Sunday Observer how these diseases can damage the body and how they can be prevented with healthy lifestyles.
Excerpts...
Q. The British College of Applied Studies ( BCAS) recently launched its MBA course in Sri Lanka. As an MBA student of the BCAS I understand you have specialised in liver diseases which included liver diseases in Sri Lanka. How is researching in this particular field linked to your current field of studies as a student doing his MBA in computer science? Is there a link with the BCAS and the University of Wolverhampton which I understand has an extensive range of research studies on liver diseases?
A. As a Biomedical Science student who completed my BSc Hons in Biomedical Science affiliated with the University of Wolverhampton in BCAS recently, my second year project was on liver disease in Sri Lanka. It was based on a review study carried out with the help of several findings and results obtained from various local research studies on the same subject.
Q. Digestive and liver disorders are widely prevalent problems in South Asian countries. Are there specific types of liver diseases more common in Sri Lanka?
A. Liver disease is a growing problem in Sri Lanka, which has been justified over the last decade or so. The latest liver disease mortality index in the country records 4,837 deaths. This disease a growing concern in Sri Lanka. In 2010 only a reported 3,435 deaths were recorded which shows an increase of 1,402 deaths over the past 7 years.
Q. What were the causes that led to this sudden increase?
A. Most commonly, alcoholic liver disease is prominent in Sri Lanka due to the high intake of alcohol, which is around 3.7 litres taken per year in 2010 and is on the rise for each adult.
Q. What about non alcoholic related problems? Are they also common in Sri Lanka?
A. Non-alcoholic liver diseases (NAFLD) are also common in Sri Lanka and is equally present due to the prevalence of diabetes, cardiovascular diseases and high blood pressure . Females are more commonly affected with NAFLD since they have 8.4% affected with diabetes and 26.1% are overweight causing high chances of developing diabetes later, according to WHO data for 2016.
Q. What about fatty liver? Fatty liver and its link to grave health issues is not always understood by the public. Even patients who have this condition are often unaware that they have it . What are the early symptoms to look for?
A. Most commonly easy bruising is a common feature due to reduced clotting factors. Yellow colouration of the skin leads to jaundice caused by accumulation of bilirubin. Pain around the abdomen is a common sign and weight loss is present as well as weight lossmainly.
Q. What are the stages of liver diseases?
A. There are four main stages for liver disease in NAFLD. It starts with steatosis, a condition in which fat begins to deposit on the liver cells leading to hardening of the liver causing NAFLD.
It then develops into Non-alcoholic Steatohepatitis (NASH) which causes inflammation of the liver. This causes scarring, leading to fibrosis and eventually, cirrhosis. In AFLD initially, the disease is induced by alcohol, that causes fat deposits on the liver which causes alcoholic hepatitis, and damage to the liver, eventually leading to cirrhosis.
Q. Are they the same for both men and women?
A. It is the same for both genders, the way liver disease develops.
Q. Gender wise who are more at risk of this condition and why?
A. Males are most commonly affected due to AFLD since there are more male drinkers than female. And in NAFLD, more females are affected because of the high percentage of females affected by diabetes and overweight condition.
Q. Age wise who are those most vulnerable to the disease?
A. Adults who are eligible to drink, and heavy drinkers.
Q. How does this affect the country’s economy? Its national budget?
A. This can cause a serious issue for the Government to invest on because, if more liver disease is prevalent in Sri Lanka the number of transplantations increases and the cost for managing these patients also fluctuate heavily, therefore, it is an important matter to be addressed in the future.
Q. I read that gut bacteria markers could be a ‘smoking gun’ for liver diseases and that chemical compounds produced by the bacteria in our gut could be used to spot early stages of liver disease and fatty liver. Your comments? Is there scientific evidence to back this claim?
A. Yes, bacteria markers are being investigated by several researches since during liver disease, these bacteria begin to express themselves and expose diseases such as, pneumonia and urinary tract infections. Studies are being carried out to understand the translocation and deposition of bacteria which can be used as markers for studies.
There is scientific evidence that this study will help reduce the complications of detecting liver diseases and further study needs to be carried out to ensure that this can be done.
Q. Are there any scientific evidence and studies to show there is a definite impact of alcohol on the liver? If so what are the latest findings of the BCAS?
A. Yes, there is a definite impact, as seen, the more alcohol is consumed in Sri Lanka, more the deaths by liver disease. According to the last data available 4.5 litres of alcohol has been consumed per annum per adult in Sri Lanka in 2015.
Q. Sri Lanka’s health authorities insist they have sufficient specialists in the field and the Government has already put in place many interventions to provide early detection of liver diseases in most district and base hospitals. As someone who has studied this field in depth, both, in Sri Lanka and in Pakistan, what do you see as the specific gaps that exist in Sri Lanka, which you suggest could be filled?
A..Liver disease can cause several complications in the country, liver is the main organ that filters the blood and metabolises drugs inside the body. Failure of the liver leads to less impact of drugs acting on the body causing the cost of the quality of life per patient to be high. This can lead to more transplants being carried out and increased cost of treatments. In a free health sector provided in the country, if the cost of treating patients keep increasing the overall money spent on healthcare also increases.
Q. Your word of advice in preventing liver disease?
A. Avoid excessive alcoholic consumption, avoid excessive sugar and salt leading to non communicable disease, exercise, and lead healthy life styles.