Juan and Gisela Silva have a lot to smile about these days.

One reason why, they are back to enjoying home-cooked meals together.

"Oh man, I can eat more now," says Juan. "Before I didn't want to eat anything because it would mess up my stomach and stuff because something wasn't working right."

That led Juan to his doctor's office where a series of tests revealed he had late-stage liver disease.

Watch: The silent liver disease that's on the rise among Hispanics and children

Journalists: Broadcast-quality video is in the downloads at the end of this post (2:37) Please courtesy: "Mayo Clinic News Network." Read the script

Nonalcoholic fatty liver disease (NAFLD)

"They told me I had liver cirrhosis," says Juan. "Nobody has ever told me that. They also said I needed a liver transplant, and quick."

Cirrhosis is often caused by long-term, chronic use of alcohol. However, like in Juan's case, people who consume little, or even no alcohol, can develop cirrhosis. Many, like Juan, unknowingly live with a condition called nonalcoholic fatty liver disease (NAFLD), which can lead to a more severe, aggressive condition called nonalcoholic steatohepatitis (NASH). In patients with NASH, the liver becomes inflamed and can progress to advanced scarring (cirrhosis) and liver failure. "I was never a big drinker," says Juan. "Maybe I would have a beer every once in a while. This came as such a surprise to me. I never expected this."

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. NAFLD is a buildup of extra fat in the liver that is not caused by alcohol use. In the U.S. alone, approximately 75-100 million people, are affected by NAFLD, and rates are rising. Among those most impacted, according to experts, are people like Juan, who are Hispanic.

"We know that Hispanics have a genetic predisposition to develop fatty liver disease, specifically people from Mexico, compared to other countries from Latin America," says Dr. Blanca Lizaola-Mayo, medical director of the Liver Transplant Center in Arizona. "There is a report of 48% of the U.S. Hispanic population that has fatty liver disease, meaning that almost half of the Hispanics who live in the United States have metabolic syndrome and fatty liver disease, and many of them don't even know that they have it."

The silent disease

Nonalcoholic fatty liver disease is referred to as a "silent disease" because often there are no symptoms. However, as the disease progresses, symptoms may include feeling weak, loss of appetite, and nausea. Juan admits to experiencing some of these symptoms but didn't think it was anything serious. "Sometimes I would feel tired and sleep a lot," says Juan. "I could only eat a little bit. Eventually, I just wasn't feeling myself anymore."

NAFLD is also on the rise among children. It is currently the most common liver disease in children in the U.S., affecting an estimated 8 million children and adolescents. Risk factors include obesity, high cholesterol, insulin resistance, and high blood sugar levels. "We believe that this is related to the lack of exercise and physical activity," says Dr. Lizaola-Mayo. "We're seeing more kids watching TV, playing video games, instead of being outside playing. And also their diet is super important."

Prevention

To protect against nonalcoholic fatty liver disease, experts recommend maintaining a healthy weight, eating a healthy diet, and getting regular exercise. Risk factors include obesity, high cholesterol, diabetes and high blood pressure. Experts say if caught early, lifestyle changes alone can control or even reverse the fat buildup in the liver. A blood test at your doctor's office to check liver enzyme levels can help determine your risk level. Further testing may be needed to determine your diagnosis.

Juan ended up getting a liver transplant. Now he's feeling great. He and Gisela are sticking to a healthy diet, including lots of fruits and vegetables. Juan is grateful his disease was caught in time, and also for the donor who gave him the gift of life.

"I want to thank them. I am thankful that people donate," says Juan. "I'm a donor, too. It would be great for people to accept and to donate their organs, and I want to thank the family for doing it."

Related articles:

• The rising tide of nonalcoholic fatty liver disease
• Mayo Clinic Q and A: How to manage symptoms of liver disease
• Mayo Clinic Minute: Why more liver donors are needed
• Mayo Clinic Minute: ‘Liver in a box’ is saving lives with new technology

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A recent study suggests that severe alcohol-related liver disease is on the rise, especially in young adults. There appears to be an increase in those who are at greater risk of cirrhosis, liver cancer and death, according to the study published in JAMA. And the potential cause is binge drinking.

Binge drinking is a pattern of drinking where a male consumes five or more drinks within two hours or a female consumes at least four drinks within two hours. Heavy drinking can cause hepatic steatosis, or increased fat in the liver, and alcoholic hepatitis, or inflammation of the liver. Over time, heavy drinking can cause cirrhosis, which is scarring and destruction of liver tissue.

In this Mayo Clinic Radio podcast, Dr. Doug Simonetto, a Mayo Clinic gastroenterologist and hepatologist, will discuss diagnosis and treatment options for liver disease. Also on the program, Dr. Hector Villarraga, a Mayo Clinic cardiologist, will explain the growing field of cardio-oncology. And Dr. Yonas Geda, a Mayo Clinic neurologist, will share how lifestyle factors can affect brain health.

Here's your Mayo Clinic Radio podcast.

The post Alcohol-related liver disease is on the rise appeared first on Mayo Clinic News Network.

A recent study suggests that severe alcohol-related liver disease is on the rise, especially in young adults. There appears to be an increase in those who are at greater risk of cirrhosis, liver cancer and death, according to the study published in JAMA. And the potential cause is binge drinking.

Binge drinking is a pattern of drinking where a male consumes five or more drinks within two hours or a female consumes at least four drinks within two hours. Heavy drinking can cause hepatic steatosis, or increased fat in the liver, and alcoholic hepatitis, or inflammation of the liver. Over time, heavy drinking can cause cirrhosis, which is scarring and destruction of liver tissue.

On the next Mayo Clinic Radio program, Dr. Doug Simonetto, a Mayo Clinic gastroenterologist and hepatologist, will discuss diagnosis and treatment options for liver disease. Also on the program, Dr. Hector Villarraga, a Mayo Clinic cardiologist, will explain the growing field of cardio-oncology. And Dr. Yonas Geda, a Mayo Clinic neurologist, will share how lifestyle factors can affect brain health.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Alcohol-related liver disease is on the rise appeared first on Mayo Clinic News Network.

Binge drinking is a pattern of drinking where a male consumes five or more drinks within two hours or a female consumes at least four drinks within two hours. Heavy drinking can cause hepatic steatosis, or increased fat in the liver, and alcoholic hepatitis, or inflammation of the liver. Over time, heavy drinking can cause cirrhosis, which is scarring and destruction of liver tissue.

On the next Mayo Clinic Radio program, Dr. Doug Simonetto, a Mayo Clinic gastroenterologist and hepatologist, will discuss diagnosis and treatment options for liver disease. Also on the program, Dr. Hector Villarraga, a Mayo Clinic cardiologist, will explain the growing field of cardio-oncology. And Dr. Yonas Geda, a Mayo Clinic neurologist, will share how lifestyle factors can affect brain health.

To hear the program, find an affiliate in your area.

Miss the show? Here's the Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Alcohol-related liver disease / cardio-oncology / lifestyle factors and the brain appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Drug therapy may effectively treat a potentially life-threatening condition associated with cirrhosis and other chronic liver diseases, according to a new study by Mayo Clinic researchers. The study was posted in March on Gastroenterology, the online journal of the American Gastroenterological Association. Print publication is scheduled for July.

While therapies have been available to treat some forms of liver disease, including hepatitis C and autoimmune hepatitis, options have been more limited for treating portal hypertension, a condition where there is an increase in pressure within the portal vein that carries blood from abdominal organs to the liver. Portal hypertension is associated with cirrhosis and other chronic liver diseases.

According to the study, the drug sivelestat may effectively lower portal hypertension, improving symptoms and outcomes for those patients. The study results were obtained from mouse models but have since been confirmed in liver samples from humans, according to Vijay Shah, M.D., a Mayo Clinic gastroenterologist and senior author.

“This was an exciting confirmation of our findings and their applicability to human disease,” Dr. Shah says. “Sivelestat has been safely used in humans with acute lung injury and bronchopulmonary dysplasia. This suggests that sivelestat and similar drugs constitute a potential means to decrease portal hypertension in patients with chronic liver disease.”

The Mayo study showed that deposits of fibrin — microvascular blood clots — contributed to portal hypertension, and inflammatory cells known as neutrophils contributed to the formation of fibrin. By inhibiting neutrophil function with sivelestat, they were able to decrease portal hypertension.

“Neutrophils had not previously been identified as significant drivers of portal hypertension,” says Moira Hilscher, M.D., the paper's first author. Results were verified in two different models of chronic liver disease.

“The study paves the way for developing new drugs and repurposing of existing compounds to target inflammation in the liver driven by disease-related mechanical forces,” says Dr. Hilscher. "Given the increasing prevalence of advanced liver disease due to alcohol and obesity, this is clearly an unmet need.”

This research was funded in part by a grant from the National Institutes of Health. The authors report no conflicts of interest.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media contact:

• Joe Dangor, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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ANSWER: Receiving a diagnosis of hepatitis C can be distressing. The infection poses a risk of liver damage and, although rare, it may lead to liver cancer. Fortunately, thanks to recent advances in treatment, highly effective antiviral medication is available to treat hepatitis C. At this point, you should consult with a physician who specializes in liver diseases to help you decide how best to proceed with your care.

Hepatitis C is a viral infection that causes liver inflammation. It is spread through contact with blood that's infected with the virus. Numerous factors have been associated with an increased risk for this infection, such as receiving a blood transfusion or organ transplant before 1992, injection of illicit drugs, and receiving a tattoo or piercing with equipment that is contaminated. People born between 1945 and 1965 have the highest rate of hepatitis C infection, and they should be tested for the virus.

Most individuals diagnosed with hepatitis C have had it for years without noticing any symptoms. The virus doesn't trigger symptoms until it's started to damage the liver. Progressive liver damage in the form of extensive fibrosis, or liver scarring, called "cirrhosis," occurs in about 25 percent of people with hepatitis C.

The risk of cirrhosis in people infected with the hepatitis C virus is higher among those who are obese and drink heavy amounts of alcohol. An occasional alcoholic drink is not thought to increase the risk of cirrhosis significantly.

Individuals who develop cirrhosis as a result of hepatitis C have a 2 to 3 percent annual risk of developing primary liver cancer. Those with a lesser degree of liver fibrosis typically are not at increased risk for developing liver cancer.

Even without the development of liver cancer, however, if hepatitis C is left untreated, liver damage may progress to the point that it causes loss of liver function. Eventually, that could lead to a liver transplant in a small percentage of patients.

Because it's difficult to predict who will develop serious liver damage from hepatitis C, antiviral treatment is recommended for everyone diagnosed with the virus. The antiviral medication used to fight hepatitis C is effective in eradicating the virus. By taking a single pill once a day for eight to 12 weeks, a patient has a greater than 95 percent chance of being cured permanently.

Clearing the hepatitis C virus from the body halts the progression of liver fibrosis and leads to regression of fibrosis in most cases. Side effects from the medication, when they happen at all, are minimal.

The next step for you is to ask your health care provider for a referral to a specialist in liver diseases. He or she can conduct an examination and recommend tests to evaluate your liver function and assess your degree of liver fibrosis. How quickly you'll need to begin antiviral treatment depends on the results of that assessment. — Dr. John Gross, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Infectious Diseases A-Z: Increasing hepatitis infections published 4/23/18
• El minuto de Mayo Clinic: El abecé de la hepatitis (The ABCs of hepatitis) published 4/10/18
• Mayo Clinic Minute: ABCs of hepatitis published 5/24/17
• Should you be tested for hepatitis? published 5/18/17

The post Mayo Clinic Q and A: Treating hepatitis C appeared first on Mayo Clinic News Network.

ANSWER: It is important for people in your age group to be tested for hepatitis C. Studies have shown that Americans born between 1945 and 1965 are five times more likely than other individuals to be infected with the virus. Most people who have hepatitis C do not show symptoms, so the Centers for Disease Control and Prevention (CDC) recommends that anyone who falls in the high-risk age range get tested.

Hepatitis C is caused by a virus that attacks the liver. Its effects can be serious and long-lasting. If left untreated, hepatitis C can cause liver damage, scarring of the liver tissues — a condition known as cirrhosis — and, eventually, even death. Hepatitis C is a leading cause of liver cancer and the No. 1 reason for liver transplants.

In about 60 to 80 percent of adults who become infected with hepatitis C, the virus lingers in the body. But, in most cases, it’s impossible to tell it is there without testing. As people with hepatitis C age, the virus slowly damages the liver over time. Many people with hepatitis C don’t know they have the infection until liver problems show up. That’s often decades after the initial infection. It’s estimated that if everyone in the recommended age group is tested for hepatitis C, it could prevent more than 120,000 deaths from liver disease.

The hepatitis C virus is spread from contact with contaminated blood. The reason for the higher hepatitis C infection rate in baby boomers is not entirely clear. It may be linked to the fact that, before 1992, blood screening tests for hepatitis were not as reliable as they are now. So, it was possible to get the virus through a blood transfusion or an organ transplant without knowing it.

Some people may have become infected with hepatitis C by sharing contaminated needles when injecting drugs. This can happen even if a person comes in contact with an infected needle only once. In many people, it is not possible to know how they became infected. No matter what the source of a hepatitis C infection, it is critical that it be detected.

Blood tests are available that can identify the hepatitis C virus. When the virus is found, it may be necessary to take a small sample of liver tissue — a procedure called a liver biopsy — or have other tests done to determine the severity of liver damage. Results of these tests can help guide treatment decisions.

Hepatitis C infection is treated with antiviral medications that can clear the virus from the body. Usually, a combination of these medications is taken over several weeks to several months. Twelve weeks after the treatment is completed, another blood test is done to check for hepatitis C. If the virus is still present, a second round of treatment may be recommended. In the vast majority of cases, no further treatment is necessary beyond that.

I strongly encourage you to be tested for hepatitis C. For everyone born between 1945 and 1965, as well as anyone else who may be at high risk for other reasons, being tested for this virus is a crucial step in ensuring long-term health. — Dr. Stacey Rizza, Infectious Diseases, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I was diagnosed with nonalcoholic fatty liver disease nine months ago. My doctor told me I need to lose at least 60 pounds to help with inflammation. I have tried to lose weight in the past, but nothing I do seems to work. Should I consider weight-loss surgery, or are there other ways to treat this disease?

ANSWER: The most successful treatment for nonalcoholic fatty liver disease usually includes weight loss. Controlling high blood pressure, diabetes and high triglycerides — a type of fat in the blood — also can help manage this disease. As you develop a weight-loss plan, work with your doctor and other health care providers, such as a dietitian and an endocrinologist, to help you create an approach that’s best for you.

Nonalcoholic fatty liver disease develops when fat builds up in the liver of people who drink little or no alcohol. It’s the most common liver disease in the western world. According to current estimates, between 75 and 100 million adults in the U.S. have this disorder. In most people, nonalcoholic fatty liver disease progresses very slowly. It usually doesn’t cause any symptoms and results of liver tests are normal. The disease often is found on imaging exams, such as CTs or MRIs, that are being done for another reason.

In some cases, nonalcoholic fatty liver disease eventually can damage the liver to the point that cirrhosis develops. This serious and sometimes life-threatening condition involves extensive scarring of the liver. Cirrhosis can make it difficult for the liver to work properly and may lead to liver failure.

In some people with nonalcoholic fatty liver disease, the disorder can manifest as a more aggressive form of liver disease called nonalcoholic steatohepatitis (NASH), which causes liver inflammation and scarring. In some patients with NASH the liver tests are abnormal, but they can remain normal in a significant proportion of affected patients, despite the presence of liver damage. If your doctor is concerned about inflammation in your liver, your condition likely has progressed to NASH. If so, this condition puts you at higher risk for liver cancer and for faster development of cirrhosis.

The best way to combat this liver disease for most people is with weight loss, because it can help reduce liver fat, inflammation and scarring. Typically, weight loss of at least 3 to 5 percent of body weight is necessary for fat to start disappearing from the liver cells. A greater weight loss of 10 percent is needed to improve inflammation and scarring.

Weight loss is best achieved with a combination of a low-calorie diet and increased physical activity. Your health care team can work with you to craft a weight-loss program that fits your needs. If you are obese or have medical problems that are related to obesity, your care team may recommend weight-loss, or bariatric, surgery.

For those who do not qualify for bariatric surgery or who are not ready to commit to a surgical procedure, new endoscopic techniques to assist with weight loss may be another option. One of these procedures involves placement of a balloon in the stomach to help decrease the amount of food you can eat and limit your calorie intake. The balloon is removed after six months. Although this is not an established treatment method for nonalcoholic fatty liver disease or NASH, it may be an effective way to jump-start your weight loss. Once the balloon is removed, you need to maintain a healthy lifestyle to keep from gaining the weight back.

If you are not already doing so, consider working with a physician who specializes in liver disease to monitor your condition. He or she can help you review the treatment possibilities that are right for your situation, as well as assess your liver disease regularly over time to watch for any disease progression or other complications. — Dr. Alina Allen, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota

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ROCHESTER, Minn. — Researchers at Mayo Clinic released a new study reversing current thought on the treatment of cirrhotic patients with type 2 diabetes. The study found that the continuation of metformin after a cirrhosis diagnosis improved survival rates among diabetes patients. Metformin is usually discontinued once cirrhosis is diagnosed because of concerns about an increased risk of adverse effects associated with this treatment in patients with liver impairment. The Mayo Clinic study was recently published in Hepatology.

Cirrhosis is scarring of the liver caused by forms of liver diseases, such as chronic viral hepatitis, chronic alcohol abuse and non-alcoholic fatty liver disease. This condition is the consequence of damage done to the liver over many years. As cirrhosis progresses, more and more scar tissue forms, impeding proper liver functions.

Metformin is used to treat high blood sugar levels caused by type 2 diabetes. This type of diabetes works in two ways. First, it inhibits the pancreas from producing sufficient insulin, which normally regulates the movement of sugar, glucose, into cells. Glucose is the body’s main source of fuel. Second, in type 2 diabetes the liver, muscle, and fat tissues become more resistant to the effects of insulin. The combination of decreased insulin production and insulin resistance results in an abnormally high level of glucose in the blood.

Obesity-related fatty liver disease can lead to liver inflammation and cirrhosis, and also is associated with diabetes. Therefore, type 2 diabetes is found in 37 percent of cirrhotic patients, five times more than in those without cirrhosis.

In the study, a sample of 172 patients continued taking metformin, while another 78 individuals discontinued metformin after cirrhosis diagnosis. Patients who continued metformin as part of their treatment had a significantly longer median survival than those who stopped taking the drug. During the follow up, it was discovered that none of the patients taking metformin developed lactic acidosis, which was thought to be a common side effect of the drug in patients with cirrhosis.

“Our study suggests that metformin can be used safely in cirrhotic patients. Diabetic patients who take metformin to control their blood sugar levels can continue taking metformin after cirrhosis diagnosis, if there is no specific contradiction,” says gastroenterologist Lewis Roberts, M.B., Ch.B., Ph.D., senior author of the study.

With the potential implications for a major change in current clinical practice, the researchers plan to collaborate with more institutions and use nationwide databases to further validate the beneficial effects of metformin, according to Xiaodan Zhang, D.D.S., co-author of the study.

Other study authors include: William Harmsen, Teresa Mettler, W. Ray Kim, Rosebud Roberts, Terry Therneau, and Roongruedee Chaiteerakij.

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AboutMayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150 years.mayoclinic.org, http://www.mayoclinic.org/ and newsnetwork.mayoclinic.org.

MEDIA CONTACT:
Brian Kilen or Chloe Piepho, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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