Liver diseases, a problem of the first magnitude

2023-04-24 09:43:37

The new president of the Spanish Association for the Study of the Liver (AEEH), the hepatologist Manuel Romero, has come to office with “enormous satisfaction” and several lines of action have been proposed in order to make visible that liver diseases “are are becoming a health problem of the first magnitude due to its prevalence”.

Born in 1967, Romero is head of the Liver and Gastroenterology Section of the Virgen del Rocío University Hospital, Professor of Medicine at the University of Seville and has accumulated an intense clinical, research and academic career on liver diseases.

“I am very excited. One in life is doing things and having responsibilities but being president is a position that gives me enormous satisfaction”, says Romero in an interview with EFESalud.

liver health

For the next two years that he will be in the presidency, the hepatologist has set himself the main objective of “trying to position liver health as a real problem in Spanish society.”

To do this, the AEEH works on a national strategy in order to know “what are the weaknesses, strengths, opportunities and threats that we have” in this field.

“What is true is that medicine is changing right under our noses and without realizing it, things that one thought were not happening are happening, and things that were happening and one did not see now are seen with absolute clarity and liver diseases they are becoming a health problem of the first magnitude due to their prevalence”, reflects Romero.

In this sense, it mainly affects fatty liver disease, “a tremendous problem”, which affects one in three Spaniards, acts as a catalyst for the development of complications and is closely related to metabolic disorders such as hypertension, diabetes and the obesity.

Fatty liver is characterized by the accumulation of fatty acids and triglycerides in liver cells and can cause inflammation of the organ, with the possibility of developing fibrosis and leading to chronic liver damage or cirrhosis.

The importance of prevention

For this reason, Romero advocates raising awareness of the importance of implementing prevention strategies, but not only for prevention but also for other liver diseases such as hepatitis or alcoholic liver disease.

Romero has participated in scientific committees and directed research programs of international relevance. courtesy photo

“If we detect hepatitis B in a patient, we can give him a treatment; or hepatitis C, we put him on treatment and we cure him in one hundred percent of the cases; If we detect a person who drinks alcohol and has liver damage and we get them to stop drinking it, the damage reverts and disappears”, underlines the hepatologist about the importance of prevention and early detection of liver diseases.

Improve training in hepatology

Romero has marked out a second line of action for these two years in order to improve the role of hepatology in the training of the Spanish doctor. Thus, the AEEH wants to work “hand in hand with the Ministry of Health” for the creation of a specific training area.

“It must be improved because hepatology belongs to the specialty of the digestive system, which is very good like that, but it is true that complexity has developed in the management both by diagnostic methods, by precision medicine (…) that in four years The residency does not give them time to train to feel comfortable when doing, for example, liver biopsies or endoscopies of portal hypertension”, says Romero.

For this reason, he considers that it would be very “interesting” to create this training area so that the resident “finishes training as an expert hepatologist.”

In the opinion of the president of the AEEH, the level of hepatologists in Spain would increase even more.

Precision medicine in hepatology

And a third line that Romero has set out is to work with Health, the Carlos III Health Institute (ISCIII) and hospitals throughout the development of precision medicine in hepatology.

“For example, fatty liver is clearly a disease, but precision medicine will allow us to stratify patients correctly and we will find at least six, seven different groups,” the president of the AEHH abounds. .

The Association will launch training programs in this area.

Other liver diseases of concern

Romero sees a very hopeful horizon for hepatitis C after the discovery of “super-effective” treatments that aim to eliminate this disease.

“We are very close, we are screening and there are screening programs that no longer detect any viremic patients. It is something wonderful. We have the last push left, ”she predicts.

Representation of the hepatitis C/EFE/AEEH virus

With hepatitis C in an unimaginable situation not so many years ago, fatty liver is one of the pathologies that cause the most concern, as the doctor has already commented, but there are others, such as hepatitis B, that continue to give work.

“And the dance partner for fatty liver is alcohol,” says Romero, because a person who consumes this substance and has an unhealthy liver “turns into an explosive pill.”

For this reason, the hepatologist defends a public health policy on alcohol consumption.

The silence of liver diseases

One of the fundamental problems around liver diseases is the silence with which they act.

According to Romero, two out of three patients admitted to the hospital with decompensated liver disease had no idea that they had liver disease.

“Everything happens very quietly, you go through life and you don’t have a feeling of illness because the liver doesn’t hurt, so we always have to investigate to make the diagnosis as soon as possible because if not, we’re going to be late,” says the hepatologist. .

On this, Romero indicates that when a serious liver disease manifests itself, it is because all the barriers have been passed and the little that remains is the transplant “and there is not enough for everyone.”

The best way to detect liver diseases is ultrasound and blood tests, in which transaminases, platelets and the patient’s age must be observed.

With these two tools we can separate the Spanish population into two: those with liver disease that could potentially be important and those that do not.

“They are markers of great power, cheap and very easy to use”, concludes the president of the AEEH.