Non-alcoholic fatty liver disease (NAFLD) has taken us by storm globally
HEALTH BY PROF M S KHUROO
Liver disease is now established as the fifth most common cause of death after heart disease, stroke, chest infections and cancer. Disturbing is the data that unlike other major causes of mortality, liver disease is increasing over the years rather than declining. For medical fraternity worldwide, there have never been more challenges thrown by liver disease and yet there shall never be more tools/hope available with us to overcome these. Thus liver disease globally is passing through both-despair and hope; an excellent opportunity for many of us to exploit for the better.
Today we have a large pool of chronic carriers of hepatitis viruses across the globe. Estimated numbers of Hepatitis BVirus (HBV)& Hepatitis CVirus (HCV) infected worldwide are staggering -350 million and 500 million respectively. Of the 40 million HIV carriers, 3 million are infected with HBV and 4.5 million with HCV. It is estimated that HBV results in one million deaths worldwide yearly and HCV causes whooping 5 million deaths. End Stage Liver Disease (ESLD) and liver cancer constitute major causes of deaths related to HBV &HCV infections. Universal hepatitis B vaccination at birth in endemic areas has been shown to be highly effective in reducing carrier rates in children as well as the incidence of ESLD and liver cancer. Today 182 countries have now included hepatitis B vaccination in national immunization program and we must follow this in our EPI program aggressively to change the epidemiology of HBV in our country.
Hepatitis E virus (HEV) has turned out to be the most enigmatic human agent since we discovered the agent in 1980. HEV causes large-scale waterborne epidemics in developing countries involving hundreds and thousands of adult population. Around half to two-thirds of endemic hepatitis in such countries are caused by HEV. HEV has increased incidence and severity in pregnant women and is the commonest cause of acute liver failure in our society. In recent years, hepatitis E is recognized as a clinical problem in industrialized countries. HEV agent has entered in to food borne chain and is spread by consuming raw or undercooked pig livers available in super-markets in such countries. Recently we calculated HEV infections load globally. In 2005 an estimated 20 million incident HEV infections had occurred resulting in 3.3 million symptomatic cases, 70,000 deaths and 3000 stillbirths. In India alone, over 2.2 million cases of hepatitis E are thought to occur annually. Because of the impact of this infection globally it is imperative that measures be taken to control this python. Clean drinking water and safe sewage disposal are the corner stones of control, however, it may take more than hundred years before we get to drink a glass of clean portable water in India. Two HEV candidate vaccines have successfully completed phase 3 trials and ready for the prime time. As of today, HEV are not commercially available.
Non-alcoholic fatty liver disease (NAFLD) has taken us by storm globally. Kashmir is in the middle of an epidemic of metabolic syndrome and NAFLD. NAFLD is a potentially progressive liver disease and shall pose serious health problem to our community in near future. What could be the possible reasons for introduction of metabolic syndrome and NAFLD in our community of late? For sure the focus has to be our changing sedentary life style and changing food habits. You might be shocked to know that a plate of wazwan shared by 4 persons served 40,000 kilo-calories and indulgence in this delicacy shall throw any body’s metabolic system in to disarray and load liver with fat, similar to what binge drinking can do in the West. So if we need to fight this metabolic syndrome and liver disease caused by NAFLD, we need to be on roads and gyms rather than driving luxurious cars, go back to our delicious Haak (Cabbage) and rice rather than delicacy of Wazwan and maintain a body mass index at least under 25.
In this despair and hope for challenges posed by liver disease, where does liver transplantation stand? Should we talk about this esoteric advanced costly procedure once our community is infested with parasites, infections, poor portable water, bad sewage disposal and poor life style practices. My answer is yes and I shall dilate upon this to support this. It is worth mentioning that patients with ESLD and acute liver failure do not have the luxury of liver dialysis as those with renal failure patients have and liver transplant is the only hope for millions of such patients as of today. In spite of the shortage of organs and long waiting list of patients on cadaveric program Liver transplant has substantially changed management of such patients. Living Donor Liver Transplant has removed many bottlenecks and strengthened such programs in the West.
Today function has been organized to focus on awareness of liver transplant in our community. For this we have invited senior medical faculty and important members of civil society to compliment the visiting team. We have supported young physicians from various disciplines to attend this function and interact with the visiting team. It is our wish that these young minds develop interest in various aspects of liver transplant may be transplant hepatology, surgery, pathology, radiology and so on.
This interest and training shall help patients with liver diseases in Kashmir to get correct advice on transplant patients and also help those transplanted and on follow up in J&K. In future this may strengthen the ties with other transplant centers to develop a satellite liver transplant program in the State in coming years.
(Author is Ex-Director SKIMS Srinagar; Ex-Head Gastro & Liver Transplantation Program KFSH Riyadh; Director Digestive Disease Center Dr Khuroo’s Medical Clinic Srinagar Kashmir India)
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