Hi, this is Dr. Barbara Entsuah, Family Medicine Specialist. Today we will discuss Chronic Liver Diseases.
July 28th is Hepatitis awareness day. Hepatitis means inflammation of the liver and it can be caused by infectious and noninfectious conditions. Infectious causes include viruses, (e.g. Hepatitis A-( HAV), B (HBV), and C (HCV), D, E, CMV etc. ) bacteria, and fungi. Noninfectious causes include excess Alcohol use, Autoimmune diseases, drugs e.g. excess acetaminophen and Isoniazid use, and certain diseases affecting how the body processes substances (metabolic diseases).
HAV is transmitted by contaminated food and water and small incidence of sexual causes, while B and C are caused by infected blood (e.g. blood transfusion) and body fluids. Other causes are intravenous drug use, mother/baby transmission via birth canal and sexual intercourse with an infected person.
Hepatitis can also be classified as (a) acute when it comes on quickly with signs of liver damage (e.g. jaundice, and abnormal liver tests). This can be treated or it is cleared by the body’s immune system, or (b) chronic- when a virus persists 6 months after initial disease as in Chronic Hepatitis B (CHB) and Chronic Hepatitis C (CHC).
Why Chronic Viral Hepatitis is Important
Worldwide about 296 million people are living with hepatitis B and 58 million with Hepatitis C. 1.5 million were newly infected with CHB in 2019 (WHO). Chronic infections are more common in Asia, Africa, South America and the Caribbeans. In these countries 5 to 15% of the population may carry HBV.
Hepatitis C is a common cause of liver disease, and in the US about 75% of patients with HCV develop chronic liver disease. About 2.4 million in the US have CHC infection.
Both infections from CHB and CHC can be made worse when an individual has infection with HIV, Hepatitis D, heavy alcohol intake and the presence of the fungus called Aflatoxin.
Aflatoxins and Liver Cancer
About 4.5 billion people in the world are exposed to Aflatoxin contaminated foods. These may be found contaminating crops like maize (corn), millet, rice, cassava, peanuts, and tree nuts. Farm workers may be exposed by inhaling dust, others are exposed by eating contaminated foods or even eating meat or drinking milk of animals fed with infected feeds. Infections with these along with liver damage caused by excess alcohol intake can increase the risk of developing cirrhosis of the liver and subsequent cancer of the liver called Hepatocellular carcinoma(HCC).
Adolescents and children drinking contaminated products like milk, millet or maize beverages are at an increased risk for growth retardation, decreased immunity, and risk of developing HCC later on in life because Aflatoxins cause damage to DNA resulting in liver cancer. About 5-28% of all global cases of HCC are caused by Aflatoxin. They also cause gall bladder cancer.
PREVENTION OF CHRONIC HEPATITIS
It is important to get tested for Hepatitis A, B, C if you live in an endemic area
Get vaccinated against Hepatitis A and B. There is currently no vaccine for Hepatitis C. Vaccination against HBV protects one against Hepatitis D.
Practice good personal hygiene like hand washing and keeping your surroundings clean
Washing fruits and veggies well before eating and throw out any molded grains or nuts
Be in a monogamous relationship and use condom if necessary
Make sure tattoos or body piercing are done using sterilized instruments
Drink bottled water if there is chance of contaminated water at places your visit
Avoid excessive alcohol intake and if addicted get help. There are drugs to help with this
If working in health care avoid getting needle stick injuries and practice good infection control
On a national level, prevention of aflatoxin contamination is done by Public Health and Agriculture officials- e.g. by treating crops to prevent contamination, public health vigilance to make sure foods from the farm to the store shelves are safe and education of farmers and public about contamination of crops and animal products.
Diets consisting of carrots, parsley, Cummin, curcumin (turmeric) parsnips, celery, dill, caraway may help reduce cancerous effects of aflatoxin.
Get treatment for Chronic Hepatitis B and C if you are infected with any of these. Treatment used to be long but now there are newer medications taken for a shorter time with little side effects.
Use of Milk Thistle supplement may improve alcoholic and drug induced liver disease and cirrhosis
Please share on your social media platforms if you have been blessed by this.
Dr. Barbara Entsuah MD, (MHSc. Fellow GCPS, Author, speaker)
Check my webpage: www.Barbaraentsuah.com