Flavia Mendes, MD
Nonalcoholic Fatty Liver Disease (NAFLD) is the term used for the buildup of extra fat within liver cells in individuals who consume little or no alcohol. This buildup of fat can cause inflammation and fibrosis (scarring) of the liver.
NAFLD is extremely common, and it is recognized as the most common liver disorder in western countries, including in adolescents and preadolescents. It affects about 1 in 25 adults in the United States (3 to10 times more common than Hepatitis C). NAFLD is diagnosed in approximately 8 out of 10 patients who are evaluated for abnormal liver tests.
What Causes Fatty Liver?
The exact cause is not known, but the main risk factors include obesity or overweight; diabetes; high cholesterol and/or triglycerides; and high blood pressure. Rapid weight loss and poor eating habits, as well as medications, may also cause fatty liver even in patients without those risk factors.
Most of the time, NAFLD does not cause any serious liver problems and most people with fatty liver will live as long as those without it; however, the disease can progress, leading to inflammation of the liver tissue, which is also called Nonalcoholic Steatohepatitis (NASH). The persistent inflammation can cause scarring, which ultimately can lead to cirrhosis of the liver. Patients with cirrhosis may develop complications such as liver cancer and liver failure, and may need liver transplantation. It is difficult to predict the course of this disease, but we know that patients who are older, diabetics and/or obese are the ones at higher risk for worse disease.
Why Should You Ask Your Doctor About Fatty Liver?
Fatty liver is usually silent; it causes no signs or symptoms until it is very advanced. It is commonly first noted by the finding of abnormal liver tests on routine blood work. If diagnosed early, liver damage can be prevented.
If your doctor suspects that you may have fatty liver, you will need blood tests to help exclude other causes of liver disease. Imaging studies (such as ultrasound) will likely be ordered and they may show fat accumulation in the liver. In some cases, a liver biopsy may be needed to confirm the diagnosis and/or to determine the severity of the disease.
Is There a Cure?
NAFLD cannot be cured, but it can be controlled, and prevented. There is no medication proven to effectively treat fatty liver disease. The treatment/prevention is focused on diet and exercise, aiming gradual weight loss and tight control of the associated conditions, such as diabetes, high blood pressure and high cholesterol/triglycerides.
If you have been diagnosed with fatty liver, you should strive to maintain a healthy weight with balanced diet and exercise; limit alcohol intake; only take medicines that you need and follow dosing recommendations; see your doctor regularly and consider a consultation with a liver specialist.
Colorectal cancer (cancer of the large intestine or rectum) is the second most common cause of cancer deaths in the United States. Around the world, it is the second most common cancer diagnosed in women and the third most common cancer in men. Approximately 5 in 100 people without risk factors will develop colorectal cancer in their lifetime.
There are several factors associated with increased risk of developing colorectal cancer, including age, family history of colon cancer, inflammatory bowel disease and African American race. This cancer is uncommon in people younger than 40 years old, and the majority of the cases occur after 50 years of age. An individual with a single first-degree relative with colon cancer has a twofold risk increase of developing colon cancer when compared to the general population.
Several studies have shown that physical activity, consumption of fruits and vegetables and high fiber content in the diet may decrease the risk of colorectal cancer. Additional steps you can take include avoiding smoking, excessive alcohol, and the consumption of red meat.
Most cases of colorectal cancer begin as small “growths” called polyps (or adenomas). Over time, these polyps may grow and become malignant (cancerous). Screening tests have been developed to detect polyps and prevent them from transforming into cancer and/or to detect colon cancer at an early stage, allowing for successful treatment and decreasing the chance of death from the disease.
Current guidelines recommend that all adults be screened for colorectal cancer starting at the age of 50, even if there are no signs or symptoms of the disease. Patients with risk factors such as family history and inflammatory bowel disease should also be screened. African Americans may need to start screening at an earlier age and/or more frequently than the general population. Once adenomatous polyps are detected, the person is also considered at increased risk and will require surveillance with examination at shorter intervals. Regular screening has been shown to reduce the risk of developing colorectal cancer by up to 90 percent.
A Colonoscopy is the most complete screening test available, as it can detect most small polyps and almost all large polyps or cancers. It has the advantage of allowing for removal of the detected polyps, preventing the development of cancer. If a lesion suspicious for cancer is found, biopsies can be done at the same time for diagnosis.
If you are 50 years of age or older, or if you have any of the risk factors listed above and have never had a colonoscopy or other screening tests for colorectal cancer, you should discuss this with your physician. Colorectal cancer can be prevented!
Hepatitis C virus (HCV) is a leading cause of liver-related mortality and the number one indication for liver transplantation in the United States.
On May of 2011, the FDA approved 2 new drugs for the treatment of chronic Hepatitis C:
- Incivek (Telaprevir, by Vertex) 700mg (two 350mg tablets) three times daily with food
- Victrelis (Boceprevir, by Merck) 800mg (four 200mg capsules) three times daily with food
These new treatments are also referred to as direct antiviral agents (DAA¹s). The use of DAA¹s in clinical practice comes nearly a decade after the implementation of pegylated interferon and ribavirin as the standard of care for the treatment of HCV, which was only able to cure less than half of the treated patients. The DAA¹s have been anxiously waited for and they will significantly improve our ability to treat patients with hepatitis C.
Candidates for treatment with the new regimen include:
- Adult patients (over the age of 18), infected with genotype 1 hepatitis C virus
- Patients who have compensated liver disease, including cirrhotic stage disease
- Patients who were never treated (treatment naïve) or have previously failed interferon-based therapy.
Both Victrelis (Boceprevir) and Incivek (Telaprevir) are designed to be used only in combination with pegylated interferon and ribavirin. They are not to be used as by themselves due to the high rate of resistance development.
This scientific progress without a doubt opens a new era in the treatment of hepatitis C. The physicians and liver specialists at Gastro Health are all excited with the improved treatment efficacy and the possibility to help our patients who have been long waiting for a new hope in fighting against this disease.