Fatty liver disease, also called nonalcoholic fatty liver disease (NAFL), is caused by excess fat deposited into the liver. It is a silent disease with few or no symptoms, most often first noticed by a primary care physician who orders routine lab work, a computed tomography (CT) scan or an ultrasound. Based on the results of labs or scans, the physician then will refer the patient to a gastroenterologist for evaluation. Nonalcoholic steatohepatitis (NASH) is fat accumulation in the liver with inflammation, and can progress to cirrhosis – and ultimately liver cancer – if not addressed.
Approximately 30 percent of the population is affected by fatty liver disease in the United States. Some symptoms include pain or swelling in the abdomen, enlarged spleen, yellowing of the skin or eyes (also known as jaundice) and dilated veins in the esophagus. According to board-certified and fellowship-trained gastroenterologist Dr. Andrew Canning from Blount Memorial Physicians Group – Gastroenterology, fatty liver disease is becoming a significant issue and burden on our health care. “It’s becoming one of the more common causes – if not the leading cause – of liver disease in the United States. A lot of our patients think that alcohol causes liver disease, but fatty liver disease often begins with poorly controlled diabetes, being overweight, high cholesterol and those kinds of risk factors often associated with metabolic disease or an elevated body mass index (BMI). Outside of alcohol and viral hepatitis, it’s the number one cause of liver disease,” Canning added.
Currently, there are limited medication options to treat fatty liver disease. The most common treatment to reverse the disease is weight loss. In most cases, even a five to 10 percent loss in weight can significantly reduce the amount of fatty liver disease. In some instances, weight loss and exercise can be supplemented with weight-loss surgery, such as intragastric balloon or endoscopic sleeve gastroplasty, to reduce the disease. “Typically, the treatment strategy that we give patients for fatty liver disease is weight loss, in addition to simply mitigating the risks associated with damaging the liver. So, we’re making sure our patients don’t drink any alcohol, making sure they aren’t on hepatotoxic drugs or over-the-counter supplements, and if they are on any medications, that we monitor their liver function tests periodically so we don’t see them worsen over time,” Canning explained.
Liver function tests are checked every three to four months, and doctors monitor symptoms and side effects and evaluate complications related to liver disease while checking for scarring, which increases the risk of liver cancer. “Not every patient who has fatty liver disease progresses to cancer,” Canning said. “It’s kind of a spectrum of illness – there’s a fatty liver, there’s fatty liver associated with inflammation and then there’s fatty liver associated with scarring of the liver, or cirrhosis. The long-term risk for a fatty liver to advance to cirrhosis is around five percent, but when inflammation or NASH is present, that number jumps to 20 percent,” Canning added. It’s at that stage that a liver transplant may become the last option.
For more information or to make an appointment with Blount Memorial Physicians Group – Gastroenterology to evaluate fatty liver disease, call 865-980-5060.