How do we stop liver diseases with skyrocketing prevalence?


Liver : Challenge 2023

This document includes a total of fifteen strategic objectives, classified into three large areas of action.

The importance of focusing efforts on the prevention of cirrhosis and liver cancer has been recognized

  • Diego Buenosvinos
  • Specialist in Health journalism at OKDIARIO; responsible for Communication and Press at the León College of Nursing. Previously, editor-in-chief at Crónica el Mundo de León and collaborator at Onda Cero. Distinguished with the gold medal of the Provincial Council of León for information and dedication to the province and author of books such as ‘The art of caring’.

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

This document includes a total of fifteen strategic objectivesclassified into three large areas of action: prevention, diagnosis, treatment and follow-up. These challenges allow us to define the comprehensive strategy aimed at holistically addressing liver diseases and improving their management at the national level with vision 2032. To this end, up to 80 specific prioritized lines of action by the expert groups of each liver pathology, resulting in a total of 53 lines of action that will make up the National Liver Health Plan.

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

The primary objective It consists of giving priority to prevention and early diagnosis, since both aspects play a fundamental role in interventions that modify the natural history of these diseases given that previously, nihilistic therapies have been followed that did not actively intervene in the course. of these diseases, which has led to the need to take action in order to improve clinical results and quality of life of patients.

In this sense, The importance of focusing efforts on the prevention of cirrhosis and liver cancer has been recognized, which usually arises as a complication of chronic liver diseases, as well as in the reduction of the need for liver transplants, which represent the majority causes of liver transplantation in our environment. To make it, precision medicine emerges as a technique aimed at transforming clinical research and patient care itself, offering greater characterization of minority liver diseases.

How do we stop liver diseases?: the prevalence of obesity and alcoholism skyrockets

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

In fact, one in five Spaniards is at risk of suffering from liver disease and pathologies related to this organ already represent the third cause of premature death in Spain. This rise in incidence is related to the increase in unhealthy habits and lifestyles, such as alcohol abuse, an unhealthy diet and a sedentary lifestyle, among others.

Specialists are especially concerned about the increasing prevalence of both the disease known as fatty liver (metabolic hepatic steatosis), linked to obesity and type 2 diabetes, cLike liver disease related to alcohol consumption.

The first is already the most prevalent liver pathology in Spain, as it is estimated that it affects three out of every ten Spaniards, and both have already displaced viral hepatitis as the main cause of cirrhosis, liver cancer and indication for transplant, with the particularity In addition, the incidence of these two pathologies is not only advancing, but it is doing so at increasingly younger ages. In fact, in the last decade, cases of liver cancer due to fatty liver have tripled.


Hepatitis C

For his part, the doctor Jose Luis Callejadeputy head of the Gastroenterology Service at the Puerta de Hierro Majadahonda University Hospital (Madrid) and president of the AEEH, has detailed that the document aims to «itry to influence politicians about the importance of investing in health», as the National Hepatitis C Plan did in 2015. «This Plan, in four years, managed to cure more than 260,000 people from hepatitis C. The number of people who need a transplant has been reduced from 49 to 12 percent in 2022 “We have shown that, in liver, investing means saving,” he recalled.

The Plan therefore focuses on prevention and early detection. «Diet and exercise is prevention and treatment, taking into account that there is no drug treatment for fatty liver», he explained for his part Dr. Rocío Aller, specialist in the Digestive System at the Clinical Hospital of Valladolid, and secretary of the AEEH. As she has specified, the treatment “is based on the Mediterranean diet”, although this has to be personalized and accompanied by new technologies, such as the use of artificial .

Furthermore, the Plan considers it essential to address alcohol consumption at increasingly younger ages, as it is already the first cause of the development of cirrhosis and the need for liver transplantin addition to being behind more than 50% of liver cancers.

Likewise, it is considered essential to take decisive interventions to prevent obesity, which is behind the progression of fatty liver, which already affects more than 10 million Spaniardsof which nearly two million would present inflammation of the liver (steatohepatitis) and, of them, 400,0000 would already present liver cirrhosis.

Early detection

In relation to early detection, the great difficulty is that liver pathologies are “silent” diseases, according to experts, since their symptoms are non-specific and do not manifest until the liver shows significant damage. However, early diagnosis is essential to change the prognosis of the disease. Thus, for example, a change in diet and physical activity allows the disease to be reversed 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 daydrinking, obesity or alcohol abuse. Furthermore, more than 90% of liver cancer cases appear in people with chronic liver disease, “which could allow early diagnosis of this disease,” according to Aller.

Beyond fatty liver and liver diseases associated with alcohol consumption, the Plan also includes viral hepatitis, which it considers “an unresolved challenge.” Thus, Dr. JAvier Crespo, head of the Digestive System service at the Marqués de Valdecilla University Hospitalhas called for equity in vaccination against hepatitis A and B. “Although we have made a lot of progress in treatments in Spain, one in four patients we treat for viral hepatitis has advanced liver disease,” he explained.

During the meeting, the president of the National Federation of Liver Transplants was also present, Eva Perez Bech, who has lamented the stigma surrounding liver disease. «It seems that patients have asked for it due to their lifestyle habits. Liver patients suffer a lot and in silence because they do not dare to say it,” she commented.

Finally, the Plan also addresses the minor liver diseases (classified into three groups: autoimmune, toxic-metabolic and vascular-hepatic), emphasizing the importance that precision medicine must have for a better characterization of them and thus enable better care and clinical practice with patients. The need to invest in research in this area is also emphasized.

«The Plan was born with the aim of combining the experience that we have developed in the hepatology of the last 50 years. Between now and 2032, political decision-makers must be able to shed light on the Plan and achieve norms and laws that regulate both the beneficial and negative aspects, because that will be the basis for ensuring that in 2032 we do not have hepatitis C of any kind,” he said. finalized.



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