The liver is the second largest organ in our body and should be given the same importance as the brain and the heart. It is a key player in the body's digestive system. The liver functions are very important in our body and contribute to the digestive functioning for effective metabolism. Over the past decade, there has been a steady rise in the number of cases of liver diseases. World Liver Day is observed in the month of April every year. On this occasion, Medicircle is speaking to eminent gastroenterologists and hepatologists to build awareness about the significance of healthy functioning of the liver and how we can keep our lives more and more healthy. 

Dr. Gaurav Gupta has fellowship in the American Society of Transplant Surgeons, Indian Society of Transplant Surgeons, and also Association of Surgeons of India. He is presently associated with Fortis Hospital as Head of Liver Transplant and HPB Surgery Department. He has been instrumental in establishing three-level transplant units in Maharashtra. Dr. Gaurav Gupta is a certified abdominal organ transplant surgeon with more than 10 years of experience in liver transplant surgeries. Being the chief surgeon of liver transplants in Mumbai, he has performed more than 500 liver transplants in the past five years. Dr. Gupta also has performed the first-ever combined liver and kidney living donor transplant in western India. 

Fatty liver is dangerous to health

Dr. Gupta mentions, “Fatty liver has become such a common problem. If we see 100 ultrasound reports, 30 % of them would show fatty liver and people have been living normal lives with it. Fatty liver is a huge spectrum of diseases. At the start, it is a benign, normal thing. But if we don't treat it, if we don't pay enough attention, they can create a problem in the long term. Fatty liver is fat in the liver that can come from diabetes, hypertension, obesity, high cholesterol – it’s a lifestyle disease.

Fat build-up in the liver causes inflammation in the liver. So, we need to stop the process just before the inflammation stage as once the inflammation starts, it can lead to what we call Nonalcoholic steatohepatitis (NASH) or liver failure from the fatty liver. So that's the problem that the fatty liver poses. Fatty liver is reversible in the initial stages. If we ignore the problem at this stage, it causes liver damage,” says Dr. Gupta.

Lifestyle leads to liver damage

Dr. Gupta emphasizes, “It's all in our lifestyle. We eat more processed food. We are not consuming enough green leafy vegetables and fruits. Our eating habits are such that due to work, we tend to skip lunches and then after 12 hours suddenly take a big meal and then we go to bed. So, these are all wrong lifestyles which is the reason for lifestyle diseases. Stress in workplace stress, in life, all have its effects. Mindsets and physical conditions are all interrelated. So, that is basically what creates problems like liver ailments.”

NASH is liver fat without alcohol

Dr. Gupta mentions, “We hardly saw cases of NASH in India previously. In the USA, the cases of NASH were higher than here, when I went for my fellowship. Now 40% of my patients are suffering from NASH. It’s becoming a pandemic. Incidences are progressively increasing because lifestyle diseases are progressively getting worse. We are not realizing, how much it can affect us and the cause is our bad lifestyle.”

Liver cirrhosis is irreversible damage to the liver

Dr. Gupta explains, “Liver cirrhosis is irreversible damage to the liver. If we keep on injuring our liver with a bad lifestyle, initially it will be ok. But if there is a continuous injury the liver swells and becomes hard as stone, edges become irregular. This is cirrhosis and it is irreversible. Alcohol, autoimmune diseases, hepatitis B, hepatitis C, NASH, slowly cause permanent damage to the liver. Cirrhosis is also a wide spectrum and can be categorized as early cirrhosis (stage A), middle cirrhosis (stage B), and late cirrhosis (stage C).

Stage A - A normal and thorough sonography or CT Scan can diagnose it. No medical or surgical treatment is required. Just exercise and diet are sufficient.

Stage B – Problems start from this stage, fluid gets accumulated in the abdomen, there is jaundice, kidney damage, ammonia level increases, blood vomits. With medical management, the patient recovers generally. It is an indication that the liver is damaged and is at a critical stage

Stage C –No medicine or treatment like gene therapy can cure. Liver transplant is a solution in this stage,” says Dr. Gupta.

Annual health checkups are a necessity

Dr. Gupta advises, “There are multiple reasons for cirrhosis like an iron deposit in the liver, genetic disorder, etc. 15 -20 percent of people's reason for liver damage remains a mystery. The main issue is that at the early stage, there are no symptoms for months and years while the liver is getting damaged. It comes to the picture at the irreversible stage. So, it is very important to get yearly health checkups which consist of LFT, sonography of abdomen, etc. so that the problems get identified at the treatable stage.”

Liver transplant has come a long way

Dr. Gupta informs, “Liver transplant is relatively a new field. In our country, it started after 2004-2005. Liver transplant has come a long way and has become standardized now. It is quite a safe procedure even though it is complicated. There is a 95 % success rate which is very good. If there are complications after transplantation, it generally happens in the first 3 months. If there is no problem, then the patient lives with that liver for up to 15-20 years without any problem. The cost of liver transplants is a misconception. 2 years ago, I did a liver transplant for an 18-year-old girl. Her father was a tailor. When she came with the problem, she had already spent 5 lakh rupees in the medical management of the disease. The transplant saved her that recurring cost year after year. So transplant is a one-time cost but lots of cost in medical management and hospitalization gets saved," says Dr. Gupta.

(Edited by Amrita Priya)