How can we stop the rapidly increasing prevalence of liver disease?

Liver Health: The 2023 Challenge

This document includes a total of fifteen strategic goals, grouped under three major action areas.

The importance of focusing efforts on the prevention of cirrhosis and liver cancer is recognized.

The Spanish Association for the Study of the Liver (AEEH) announced on Tuesday National Liver Health Plan: The 2032 Challenge.which was recently presented to the Ministry of Health, in order to promote prevention and early diagnosis of liver diseasesthe incidence of which is increasing in Spain.

This document includes a total of fifteen strategic goalsdivided into three large areas of activity: prevention, diagnosis, treatment and follow-up. These challenges allow us to define a comprehensive strategy to comprehensively address liver problems and improve their treatment at the national level within the framework of the 2032 vision. 80 specific priority areas of activity expert groups for each liver pathology, resulting in a total of 53 action areas that will constitute National Liver Health Plan.

The Spanish Association for the Study of the Liver (AEEH) has developed National Liver Health Plan: The 2032 Challenge. which was conceived in response to the growing increase in chronic liver pathologies, which have acquired significant relevance due to their close connection with the epidemic of obesity and type 2 diabetes mellitus (DM). Among these diseases, metabolic hepatic steatosis (NASH) stands out. ), alcohol-related liver disease and viral hepatitis. In addition, liver cancer, including hepatocellular carcinoma and cholangiocarcinoma, and finally liver transplantation.

primary goal It is to prioritize prevention and early diagnosis, since both aspects play a fundamental role in interventions that change the natural history of these diseases, given that previously nihilistic treatments were used that did not actively intervene during the course of these diseases. what led to need to take action to improve clinical outcomes and quality of life for patients.

In this sense, The importance of focusing efforts on the prevention of cirrhosis and liver cancer is recognized., which usually occurs as a complication of chronic liver diseases, and also with the decreasing need for liver transplantation, which represents the majority of the reasons for liver transplantation in our environment. Do it, Precision medicine is emerging as a method aimed at transforming clinical research and patient care by offering more detailed characterization of certain liver diseases.

“The situation in Spain is that morbidity and mortality associated with liver diseases are increasing, while for other diseases it is decreasing, as is the case with mortality from cancer or cardiovascular diseases,” he warned. Dr. Manuel Romero, Head of the Digestive System Department at the Virgen del Rocío University Hospital in Seville, at an information meeting organized by Europa Press.

Actually, One in five Spaniards is at risk of developing liver disease and pathologies related to this organ already represent the third cause of premature death in Spain. This increase in incidence is due to the increase in unhealthy habits and lifestyles such as alcohol abuse, unhealthy diet and sedentary lifestyle, among others.

Experts are particularly concerned about the growing prevalence of a disease known as fatty liver (metabolic steatosis of the liver), associated with obesity and type 2 diabetes, cAs do liver diseases associated with alcohol consumption.

The former is already the most common liver pathology in Spain, as it is estimated to affect three out of every ten Spaniards, and both have already replaced viral hepatitis as the main cause of liver cirrhosis, liver cancer and indications for transplantation, with features In addition, the incidence These two pathologies not only grow, but also occur at an increasingly younger age. In fact, the incidence of liver cancer due to fatty liver has tripled over the past decade.

Hepatitis C

For his part, the doctor Jose Luis CallejaDeputy Head of the Gastroenterology Service of the Puerta de Hierro Majadahonda University Hospital (Madrid) and President of the AEEH, detailed that the document aims to “try to influence politicians about the importance of investing in health care”, as the National Hepatitis C Plan did in 2015. “This plan has cured more than 260,000 people from hepatitis C in four years. The number of people needing a transplant has dropped from 49 percent to 12 percent in 2022.” We have shown that in the liver, investment equals savings,” he recalled.

The Plan therefore focuses on prevention and early detection. “Diet and exercise are prevention and treatment, taking into account that there is no Drug treatment of fatty liver“, he explained for his part Dr. Rocio Aller, digestive specialist at the Clinical Hospital of Valladolid and secretary of the AEEH. As specified, the treatment is “based on the Mediterranean diet,” although it must be personalized and accompanied by new technologies, such as the use of artificial intelligence.

In addition, the Plan considers it necessary to combat alcohol consumption at an increasingly younger age, since this is already the first cause of the development of liver cirrhosis and the need liver transplantin addition to being the cause of more than 50% of liver cancer cases.

Likewise, it is considered important to take decisive action to prevent obesity, which is the cause of the progression of fatty liver disease, which already affects more 10 million Spaniardsof which almost two million will have liver inflammation (steatohepatitis), and 400,000 of them will already have cirrhosis.

Early detection

Regarding early detection, the big difficulty is that liver pathologies are, according to experts, “silent” diseases, since their symptoms are non-specific and do not appear until the liver experiences significant damage. However, early diagnosis is necessary to change the prognosis of the disease. For example, changing your diet and physical activity can reverse the disease in more than 80 percent of cases.

For all these reasons, the Plan emphasizes the need to screen for liver disease in all people who have risk factors such as daytimealcohol consumption, obesity or alcohol abuse. Additionally, Allaire said, more than 90% of liver cancers occur in people with chronic liver disease, “which may allow for early diagnosis of the disease.”

In addition to fatty liver disease and alcohol-related liver disease, the Plan also includes viral hepatitis, which it considers an “unsolved problem.” So Dr. J.Avier Crespo, Head of the Digestive System Service at the Marqués de Valdecilla University Hospitalcalled for equity in vaccination against hepatitis A and B. “Although we have made great progress in treatment in Spain, one in four patients we treat for viral hepatitis develops advanced liver disease,” he explained.

The meeting was also attended by the President of the National Federation of Liver Transplantation Eva Perez Bech, who deplored the stigma associated with liver disease. “Patients seemed to be asking for it because of their lifestyle. Liver patients suffer a lot and in silence because they don’t dare talk about it,” he commented.

Finally, the Plan also addresses minor liver diseases (classified into three groups: autoimmune, toxic-metabolic and vascular-hepatic), highlighting the importance that precision medicine should have to better characterize them and thus provide better care and clinical practice with patients. It also highlights the need to invest in research in this area.

“The plan was born with the goal of combining the experience that we have gained in hepatology of the last 50 years. Between now and 2032, policymakers must be able to shed light on the Plan and enact regulations and laws to address both the positive and negative aspects, as this will be the basis for ensuring that we have no hepatitis in 2032 Any kind,” he said.