This content is password protected. To view it please enter your password below:

Password:

The post Protected: Why the EU must prioritise prevention to improve public health appeared first on Health Awareness.

Rates of liver disease are increasing across the United Kingdom. It is a rapidly rising cause of death in those under the age of 65.

Since 1970, there has been between a 400-500% increase in the mortality rates for liver disease. This is in a stark contrast to most other diseases where the mortality rates have stayed stable or fallen in the same time period.

Late-stage diagnosis

Liver disease is in many ways a sneaky killer, people are unaware that they have the disease until it’s too late. Most people are often first aware that they have the problem when they present to hospital, with a severe complication such as internal bleeding or the development of massive fluid in the abdomen.

The most common causes of liver disease in the UK – which are also preventable – are related to excess alcohol consumption, chronic viral hepatitis or obesity related fatty liver disease. All three cause chronic low-grade damage to the liver where it is progressively replaced with fibrosis leading to cirrhosis.

Liver disease is in many ways a sneaky killer, people are unaware that they have the disease until it’s too late.

Importance of liver function tests

This development of liver disease is even more surprising given that one of the common blood tests performed on people are liver function tests. Most adults in the UK have had them at least once. The blood test is very simple and commonly taken within general practice.

However, the interpretation of these blood tests is complex as liver disease will often only cause minor abnormalities, despite leading to serious complications. These abnormalities are difficult to detect but there are techniques which combine liver function tests with a mathematical formula to identify those at high risk of progressive scarring of the liver.

These mathematical calculations are not commonly available nor are they well understood by the average primary medical care provider.

Greater awareness and education needed

The British Society of Gastroenterology has highlighted members who have developed services that make these calculations routinely available to GPs to allow early detection of liver disease.

For example, in South Wales, there is the “Gwent Liver Pathway” and in Scotland “intelligent Liver Function Testing (iLFT)” where if GPs queried liver disease or requested liver blood tests they automatically have the additional calculations performed. The information is then provided back to GPs.

There are plans afoot to make this commonplace across the United Kingdom. We are hopefully entering a time in which liver disease is routinely and automatically detected early. This gives people an opportunity to avoid the dire consequences of liver disease, by changing lifestyle at an early stage.

The post Liver disease: getting more from your blood test appeared first on Health Awareness.

Dr David James Pinato

Clinical Senior Lecturer, Imperial College London and Consultant Medical Oncologist, International Liver Cancer Association

Treatment of cancer has recognised a true revolution in the past two decades. Those who treat liver tumours could not hope for a better time to shake up clinical practice.

For way too long and despite incessant efforts from clinicians, patients, universities, charities and industry – liver tumours have remained neglected orphans from the transformative changes that chemotherapy has lent to a wide variety of cancers including breast, lung and ovary.

Demonstrating the value of therapies

Hepatocellular cancer, the most common form of liver cancer, is tough to treat as it arises most frequently in a scarred liver. Demonstrating that drug therapy was worth pursuing in this highly untreatable cancer type took years and for over a decade we only had one drug to treat it.

At medical conferences and in the clinic, more and more we hear a word being pronounced. One that we desperately needed: choice. After years of failure, there are now an increasing number of drugs that are available to patients and a disease that would prove fatal in 3-6 months can be successfully managed for up to two years in patients who respond to treatment.

We have learnt over the years that hepatocellular cancer is often invisible to our own immune system and we have developed immunotherapy to remove the “invisibility cloak” that protects cancer from our own natural defences. The same approach is proving useful in bile duct cancers, a rarer form of liver cancer from which we have learnt that combining chemotherapy and immunotherapy may be the way forward.

New drugs can be expensive and may not benefit all, so a lot of work remains to be done to make anti-cancer therapy affordable, universal and truly personalised.

Offering treatment to those in need

As novel choices for treatment arise it becomes crucial that, as a society, we are able to offer these treatments to everyone who needs them and understand who has the best chance of responding to each type of therapy. New drugs can be expensive and may not benefit all, so a lot of work remains to be done to make anti-cancer therapy affordable, universal and truly personalised.

We are at a turning point for the treatment of this disease, we have new drugs and we will have more in the near future. By working all together with the ultimate goal of improving not only the prognosis but also the quality of life of our patients, we will finally be able to offer true hope for patients affected by liver cancer.

The post Progress is being made in new treatments for liver cancer appeared first on Health Awareness.

Samantha shares her experiences of her mother suffering with non-alcohol related fatty liver disease (NAFLD). Greater awareness of condition could help earlier diagnosis and save lives.

My mum was diagnosed with NAFLD on 19th April 2018 and sadly passed away just four days later. At her inquest, the coroner cited missed opportunities for diagnosis and treatment.

Living a healthy lifestyle

When my mum was younger, she was very active, running cross country for our local county and a marathon for charity. She also maintained a healthy diet. However, her mobility was destroyed by osteoarthritis and spondylitis, which led to her weight gain and subsequent knee replacement surgery.

My mum knew she had problems with her liver having had multiple liver function tests (LFTs) from 2004, which all had abnormal results. Despite this, she was not referred for any further testing as doctors did not believe she was at risk. My mum didn’t drink alcohol and avoided taking pain medication, but she was overweight which we now know to be a risk factor for NAFLD. 

Liver disease is often diagnosed late because the symptoms are either vague or non-existent in the early stages.

Noticing behaviour changes

Just over a year before her death, we started to notice changes in her behaviour. She didn’t want to eat and her mood changed, she seemed very low and worried a lot.

Following the knee replacement surgery, my mum started to experience brain fog and muscle spasms. Both brain fog and muscle spasms are common symptoms of liver disease, but we thought these were side effects of her surgery.

Rapid deterioration

After a week of antibiotics, I visited her at home, it was the first time she had left her bed in days. As soon as she walked into the living room I was shocked at her appearance. I had seen jaundice before and knew something was wrong.

We got her an emergency appointment with her GP who agreed she needed to go into hospital. She underwent a number of scans and tests over the next four weeks,i all the while deteriorating rapidly. By the time they diagnosed NAFLD it was already too late. She had developed encephalopathy and days later suffered a stroke. My mum passed away surrounded by her family in hospital.

Delays in diagnosis

Liver disease is often diagnosed late because the symptoms are either vague or non-existent in the early stages but also little is known about the disease by both the public and healthcare professionals. I think, if there had been greater awareness, as the coroner suggested, my mum could have been diagnosed earlier and may still be here today.

The post Greater awareness is needed of NAFLD appeared first on Health Awareness.

Dr Teresa Casanovas M.D

Scientific Committee Leader, European Liver Patients’ Association (ELPA)

In recent years, non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease.

Based on the official studies, NAFLD affects one in four adults and one in 10 children/adolescents in Europe1. The prevalence and incidence of the condition are expected to increase worldwide as the global obesity epidemic spreads and the trend in developing countries toward the Western lifestyle continues.

NAFLD can cause what is called the ‘domino effect’ and together with co-morbidities such as obesity, hypertension and hypertriglyceridemia can be the cause of cirrhosis and hepatocellular carcinoma. COVID-19 pandemic measures may have played an essential role in the global increase of the NAFLD ‘domino effect’ as most individuals needed to change how they live, work, study and socialise.

Pandemic changes in lifestyle

In combination with the isolation measures, these sudden changes influenced emotional and psychosocial wellbeing, as well as food habits. The pandemic has affected our lives and contributed to increasing the time we spend in front of a screen, maybe eating while watching, paying less attention to the size of the portion, or the quality of food. In addition, this means greater exposure to advertising of unhealthy products and decreased physical activity. In addition, an increase in harmful alcohol use has been reported.

It is also clear how health care systems must be improved to fight inequalities across Europe and not leave some people behind. 

New working group needed

The European Liver Patients Association (ELPA) strongly believes that 2022 is crucial to frame a set of specific action steps the EU and stop the ‘domino effect’ of the disease. A specific working group has been created within ELPA members to work precisely in that direction.

Recently, the working group, together with the ELPA Scientific committee coordinator, Dr Teresa Casanovas, has organised a survey which in the first phase aimed to:

1. Find out the knowledge level of the disease among the general population.
2. Uncover the unmet needs of people living with this disease.

The survey was translated into seven different languages, and the final results will be announced in September 2022.

International NASH day

Another critical step ELPA is taking in fighting the ‘domino effect’ is gathering all stakeholders, and discussing important, framing issues related to NAFLD patients on June 9, 2022 – international NASH day.

These two actions are essential because citizens need health literacy and updated scientific information. Politicians should introduce changes in legislation related to food and alcohol labels. It is also clear how health care systems must be improved to fight inequalities across Europe and not leave some people behind.

We are aware that liver diseases have a significant public health component and many liver diseases might be preventable; NASH is one of them.

The post How to stop the NAFLD domino effect appeared first on Health Awareness.

Non-alcoholic fatty liver disease (NAFLD) is a major chronic liver disease affecting over 24% of the world’s adult population.

While NAFLD/steatosis is benign and can be reversed with lifestyle and diet modifications, over 30% of the NAFLD population can progress to a more advanced stage known as non-alcoholic steatohepatitis (NASH), characterised by inflammation, fibrosis and cirrhosis.

Pandorum is a tissue-engineering and regenerative medicine company specialised in developing stem cell-derived therapeutics.

Addressing unmet need

NASH in effect is a pandemic of unmet clinical needs. The complications related to NASH are associated with three major components- metabolic, fibrotic and inflammatory. Further, an additional reason for failure of drugs in advanced stages of clinical trials is the lack of suitable experimental models which can reliably translate to humans.

Pandorum is a tissue-engineering and regenerative medicine company specialised in developing stem cell-derived therapeutics known as exosomes, enriched with factors to treat liver diseases involving inflammation and fibrosis. These exosomes are not only capable of reversing the disease pathology, but can also promote healthy regeneration, restoring the liver to a healthier state.

Screening therapeutic agents

At Pandorum, we address the issue of drug failure by developing 3D human liver micro-tissue (organoids) of NASH and using them as an advanced screening platform for our exosome-based therapeutics. Our disease model successfully recapitulates the transition from NAFLD to NASH and serves as a human relevant model that can predict the efficacy of drugs with high reliability. We use multi-parameter molecular readouts to capture disease reversal state when treated with exosomes and relevant pharmacological agents in the market. 

The post Regenerative nanotherapy to treat NAFLD appeared first on Health Awareness.

Treatment for patients with a rare and chronic liver condition could be significantly improved following a nationwide audit of NHS centres.

Primary biliary cholangitis (PBC) is a rare liver disease that occurs in fewer than one in 2,000 people. It is a leading indication for liver transplantation in the UK. Hepatologists from almost all NHS liver centres in the UK have recently completed an audit of management of PBC. It has raised important questions about the provision of health care for rare liver diseases in the NHS.

Slow progression

PBC is an autoimmune liver disease, resulting from a person’s immune system damaging the small bile ducts in the liver. “There is a slow progression over time and in a substantial proportion of patients, PBC eventually leads to cirrhosis. Some patients develop chronic liver failure and require a liver transplant,” says Dr Mells from Addenbrooke’s Hospital in Cambridge. It is an important cause of liver disease.

First-line treatment

The first-line treatment for PBC is ursodeoxycholic acid, which is effective in most but not all patients. Second-line treatments are available in the UK for patients whose PBC is not controlled by ursodeoxycholic acid alone.

Prescription of second-line treatment for PBC is monitored by the NHS. This has shown that the number of prescriptions issued for second-line treatments is “substantially fewer” than the number of patients predicted to need it. “That was the real prompt to do the audit,” adds Dr Mells. “It needed to be national because we wanted to be able to compare the management of PBC in specialist centres to district general hospitals and across different regions of the UK.” Dr Mells explains there were also growing concerns that PBC was not being managed in accordance with the care quality standards outlined in guidelines from the British Society of Gastroenterology (BSG).

While data from the audit are still being analysed, Dr Mells says one of the key findings is that only half of the patients eligible for second-line treatment are receiving it. “That means that patients are missing out on the treatments they need. That puts them at risk of progressive liver disease and future complications of cirrhosis,” he says.

PBC patients may also have no symptoms, so the observations that should trigger a referral for second-line treatment might be overlooked.

Lack of familiarity

Not unexpectedly, the audit also shows that prescribing rates are higher for patients managed in specialist centres compared to smaller hospitals. The reason for this disparity is unclear. One possibility, however, is that due to its rarity, treatment pathways for PBC might be less well-rehearsed in smaller centres than in the UK’s major liver hubs.

Expanding on how this might lead to patients with PBC being overlooked, Dr Mells says that specialist centres frequently have clinics focussed on the condition. Conversely, in smaller centres, rare patients with PBC are interspersed amongst those with more prevalent liver conditions.

PBC patients may also have no symptoms, so the observations that should trigger a referral for second-line treatment might be overlooked. If effective treatment is delivered earlier, however, it can prevent patients from developing complications from liver disease. “Effective treatment needs to start as early as possible to prevent progression of the disease and avoid the future need for a liver transplant,” he says.

Audit data

The audit covered all aspects of PBC management and was co-led by the Addenbrooke’s team, which found that most UK centres willingly contributed data for a national report. Project manager, Steven Flack, explains: “Each centre is going to receive their data back to identify gaps within their own centre to put procedures in place to improve treatment.” Dr Mells adds: “The broad aim is to improve care for PBC and make sure that patients eligible for second-line treatment are identified and referred to the local multi-disciplinary team.”

While this audit has identified issues that must be addressed, there is hope that it will lead to measurable improvement in care for patients with this rare liver disease in the UK.

This article has been sponsored by Intercept Pharma UK & Ireland Limited (“Intercept”). Intercept has recommended the potential authors for this article, however, with the exception of a factual accuracy check, Intercept has had no editorial control over the content of this article.

UK-PB-MED-00091
Date of Prep: March 22

The post Stepping up care standards for patients with a rare liver disease appeared first on Health Awareness.

In the last 50 years there have been enormous improvements in healthcare, yet the number of people dying from liver disease has increased by 400%.

The number of people dying from liver disease is a stark contrast to other major killer diseases, such as heart disease and cancer, in which the number of deaths have either remained stable or decreased.

Tackling delays in diagnosis

A major reason for this increase is late diagnosis. Three quarters of people with advanced liver disease are only diagnosed after an emergency hospital admission at a point when it is too late for effective treatment or intervention. A major reason for this is that liver disease develops silently and there are usually no symptoms in the early stages.

We therefore need to make early diagnosis routine by testing those who are at high risk. People at risk include those who are overweight, those with type 2 diabetes, men who regularly drink more than 50 units per week and women who drink more than 35 units.

If you look after your liver, then your liver will look after you as it has the amazing ability to regenerate.

Diagnostic support needed for GPs

Primary care is a key setting where improvement in the detection and management of liver disease is required. However, our research shows that the majority of areas in the UK do not have an effective pathway in place to diagnose liver disease in primary care. GPs need more support in making the diagnosis.

GPs need the guidelines and tools to enable them to proactively assess a person’s risk of liver disease and arrange necessary investigations or interventions. If liver disease is suspected, then the patient should be referred to a specialist team for further investigation.

Prevention is key

The liver is the body’s factory, processing everything we eat and drink. If you look after your liver, then your liver will look after you as it has the amazing ability to regenerate.

While the liver works hard and can take a lot of abuse, it is like an elastic band – it can only stretch so far before it breaks. It is estimated that 90% of liver disease is linked to alcohol misuse, being overweight and viral hepatitis.

These are three simple steps to improve your liver health:

• Drink within recommended limits (no more than 14 units per week on a regular basis) and have three consecutive days off alcohol every week.
• Eat a healthy diet and take plenty of exercise.
• Know the risk factors for viral hepatitis and get tested or vaccinated if you are at risk.

The post Improving detection and management of liver disease appeared first on Health Awareness.

Despite affecting more than half a billion people, liver conditions continue to be misunderstood and stigmatised, resulting in under-diagnosis, under-treatment and poor outcomes.

A new initiative to raise the profile of liver disease as a major public health issue is being launched globally.

Donna Cryer, CEO of Global Liver Institute (GLI), the non-profit organisation representing patients with liver disease, says: “Everyone is at risk of liver disease and should be concerned about their liver health.

“There are over half a billion people living with some form of liver disease, most of whom do not know that. That is why we feel it should be positioned in the pantheon of public health issues.”

A public health issue

The Liver Health is Public Health (LHPH) Initiative, launched this March by Global Liver Institute, will be a multiyear initiative that aims to see liver health given the same status among the general public, researchers, doctors and policymakers as heart, brain and other major health issues. GLI looks forward to working collaboratively with the more than 200 global partners across GLI’s liver councils on the LHPH initiative. The LHPH Initiative is endorsed by the Hepatology Society of the Philippines, the European Society for Organ Transplant, Liver Patients International, the European Reference Network on Metabolic Diseases, Turkish Association for the Study of the Liver and GLI’s Liver Action Network including 12 global liver patient advocacy organisations.

Founded in 2014 and based in Washington DC with offices in Rome and Edinburgh, Global Liver Institute works with partner organisations and societies in numerous countries and covers all aspects of liver health from cancer, fatty liver diseases, paediatric and rare liver diseases.

Most people do not know there are so many potential causes of liver disease, whether they are environmental, nutritional, genetic or autoimmune disease.

Through LHPH it also wants to alert people of the influence they can have on their liver health by what they eat and the exercise they take.

Cryer, who had a liver transplant 27 years ago after developing a rare autoimmune liver disease, says: “I was blessed to receive the gift of life but I hope that I can prevent people from ever needing a liver transplant. But if they do, they need to get all the innovation and care that would help them lead a healthy life.”

Reducing stigma

Although there are more than 100 different types of liver disease, the condition has been stigmatised because of a perception that it is caused primarily by alcohol.

But as Cryer points out, many cases affect children, viral hepatitis is a cause of liver cancer and one of the main conditions is NAFLD (non-alcoholic fatty liver disease).

“Most people do not know there are so many potential causes of liver disease, whether they are environmental, nutritional, genetic or autoimmune disease,” she says.

She also points out that COVID-19 has affected liver patients harshly and also created more liver patients, as some forms of COVID have caused liver damage.

The post Global Liver Institute launches a new global public health initiative in liver health appeared first on Health Awareness.

Dr Teresa Casanovas M.D.

Scientific Committee Leader, European Liver Patients’ Association (ELPA)

Over the past 20 years, there has been a 70% increase in liver cancer-related mortality in Europe.¹ From 1997 to 2016, incidence and deaths from hepatocellular carcinoma (HCC) have tripled in England.² 

Unfortunately, liver cancer is usually asymptomatic. When discovered, it could be too late. At an advanced stage, options are limited and connected to high costs. Every year €4 billion is spent in Europe on liver cancer.³ 

Lowering liver cancer incidence

The European Liver Patients’ Association – ELPA has been working in the field of advocacy for liver patients for more than 17 years. What is striking us the most is that many liver diseases could lead to liver cancer and, if treated or avoided, can lower its incidence. Almost 50% of cases are preventable, 35% of deaths could be avoided through preventive measures and lifestyle choices.

Hepatitis B and C are responsible for up to 76% of liver cancer worldwide. It means that working on hepatitis reduction and elimination is also a way to fight cancer. Fatty liver, smoking and alcohol are among the scientifically recognised liver cancer risk factors and they can be tackled by adopting a healthy lifestyle and promoting health literacy.

Therefore, we are in front of three driving forces: prevention, early screening and early detection. These are crucial because they can ensure several options for treatment. 

However, ELPA can testify how advocating this at EU level is not easy.

Hepatitis B and C are responsible for up to 76% of liver cancer worldwide.

Lack of focus on early diagnosis

When Europe’s Beating Cancer Plan was first announced, we wanted to engage with it and flag up the lack of focus on risk-stratified screening and early diagnosis in liver cancer.

However, our submission to the consultation focused on communicable diseases (Hepatitis B and C) and the Plan was officially about a non-communicable condition. We reached out to our fellow patient advocates in Digestive Cancers Europe – DiCE and other organisations. Liver cancer is now mentioned in the plan ‒ at least on the prevention front in the chapter dedicated to infectious diseases.

We regret that there is currently no mention of screening. Still, we continued to work and together with DiCE, we also drew up a White Paper ‒ Liver Cancer: No Patient Left Behind in October 2021.

We call upon all stakeholders across Europe to work together to ensure that best practices are implemented at every stage of the patient pathway in each country, giving every patient the best possible opportunity for a positive outcome.

We believe we can achieve more and faster if we work together. 

[1] Data from the Lancet Commission on Liver Diseases Dec 2022.
[2] Data from the National Cancer Research Institute (NCRI).
[3] Data from the Lancet Commission on Liver Diseases Dec 2022.

The post Liver cancer is an all-out battle appeared first on Health Awareness.