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Hepatitis C Screening

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Approximately 4 million Americans are infected with the hepatitis C virus (HCV) but many of them don’t know it. More than 75% are baby boomers (born between 1945 and 1965) and may have been unknowingly infected before HCV was discovered in 1989. It is possible to have chronic (long-term) hepatitis C infection but not to develop any symptoms for decades. Over time, hepatitis C infection can lead to cirrhosis (scarring) of the liver, end-stage liver disease, and liver cancer. In the United States, chronic hepatitis C infection is a leading cause of liver disease and liver transplants. Each year, more than 15,000 people in the United States are thought to die of complications from chronic hepatitis C infection. The most important risk factor for hepatitis C infection is the use of injection drugs. Other risk factors include having had a blood transfusion before 1992, having multiple sex partners, and getting a tattoo with an unsterilized needle.

Screening can detect the infection before it has caused serious damage to a person’s liver. Screening is most beneficial for people at high risk for being infected with hepatitis C, such as those who have ever injected drugs. People who received a blood transfusion before 1992 also are at increased risk. In 1992, the United States started checking blood donations for the virus. Since then, the risk of infection from donated blood has become very, very low. They may have been infected after a blood transfusion or from a high-risk behavior that they do not know about or have not told their doctor about. Most of the infected people in this group have been living with the disease for many years without symptoms. Some may never develop symptoms, but for many others, the infection will eventually result in liver disease.

Hepatitis C screening involves testing a blood sample to see whether it contains antibodies (disease-fighting proteins) that react specifically to the hepatitis C virus. This test is followed by a second test that determines the level of virus in the blood. When used together, these two tests accurately identify whether a person has hepatitis C infection. For some people, once hepatitis C infection is identified it can be successfully treated with medicines (antivirals) to get rid of the virus. The goal of treatment is to prevent long-term damage to the liver from the infection. In the past few years, diagnosis and treatment of hepatitis C infection has greatly improved. This makes it more valuable to identify the infection so that a person can start treatment, if necessary. Antiviral therapies have improved significantly over the years and it is now possible to take an oral medication for as little as three months and achieve nearly 100% cure rates with few if any side effects. Not everyone who is infected with the hepatitis C virus needs immediate treatment.

The providers at Naugatuck Valley Gastroenterology Consultants have extensive experience in the treatment of patients with hepatitis C (and other liver diseases). You or your doctor can contact us to make an appointment to discuss any questions or concerns you may have.

 

NAFLD

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Obesity is an epidemic worldwide and its incidence in both adults and children during the past three decades has increased dramatically. Apart from the well-known connection between obesity and the development of chronic medical conditions such as diabetes, cardiovascular disease, sleep apnea, and cancer, obesity is also a risk factor for liver disease.

Non-Alcoholic Fatty Liver Disease (NAFLD) has become a significant public health concern. Patients with NAFLD could develop Non-Alcoholic Steato-Hepatitis (NASH) which is the active inflammatory component of fatty liver disease. Over time, NASH can further progress to liver failure (cirrhosis) and liver cancer. Estimated to affect up to 20-40% of adults, NAFLD is the most common liver disorder in Western countries. In the USA, fatty liver disease has surpassed alcoholic liver disease and hepatitis C as the most common indication for liver transplantation referrals.

Though a majority of patients with NAFLD will have simple fat accumulation in the liver (steatosis), up to 30% may have NASH and, of those, up to 40% can further progress to cirrhosis and liver cancer.

The diagnosis of NAFLD is often suggested by abnormal liver function tests (LFTs) and/or the presence of hepatic steatosis on imaging studies (such as abdominal ultrasound). Confirmation of its presence can be made with liver biopsy or noninvasive means such as FibroScan. NAFLD generally has no symptoms and the diagnosis is usually suggested when abnormal liver function testing is found on routine labs or perhaps seen incidentally on imaging studies. However, even patients with normal liver function testing can have underlying liver inflammation and patients with more advanced liver disease may be overlooked.

Primary therapy for NAFLD and NASH involves diet modification, exercise and weight loss. Tighter glucose control in diabetics and therapies to reduce cholesterol/triglycerides and normalize thyroid function are also important. Unfortunately, trials of specific potential medical therapies for NAFLD and NASH have been inadequate to this point.

At NVGC, FibroScan technology is available and is becoming the preferred test for diagnosis and monitoring of patients with NAFLD, NASH, and cirrhosis. It is a simple, noninvasive and painless test performed in the office. FibroScan can accurately determine the presence and amount of fat deposition in the liver and further identify the presence of fibrosis and cirrhosis as well.

In addition, NVGC can discuss weight loss management strategies such as a consultation with our nutritionist along with emerging effective medical and endoscopic therapies (ie, ReShape balloon placement).