2023-04-26 08:31:47
He is Head of the Liver and Gastroenterology Section of the Virgen del Rocío University Hospital, Manuel Romero-Gómez, and is in charge of the Spanish Association for the Study of the Liver (AEEH). The hepatologist outlines the goals of the new legislature and the objectives in the approach and prevention of liver diseases in Spain.
What are the objectives for this new legislature?
As a first point, the important thing is to raise the need to place hepatology on the social agenda. One of the most important lines is the work as a result of an assignment made to us by the Congress of Deputies. Last June, we met with the Health spokespersons of the different political parties to put on the table the need for a national strategy to fight liver disease. Liver diseases are an important cause of mortality and greatly increase the years of life lost when most of these pathologies, if detected early, are preventable and, above all, curable.. Likewise, the high scientific level of Spanish hepatology allows us to meet at the world vanguard and it is absolutely reasonable to place that trust in the AEEH.
“Liver diseases are an important cause of mortality and greatly increase the years of life lost when most of these pathologies, if detected early, are preventable and, above all, curable”
How can early diagnosis and prevention of these diseases be improved?
There is a large number of people who arrive at the hospital already decompensated with terminal liver disease that they did not know they had. Therefore, we have to try to identify the people who are at risk of developing liver disease and act as soon as possibleosible. For example, fatty liver disease is detected fairly easily; what is needed is to be aware that this pathology exists. Of course, hepatitis C must be detected, treated and cured one hundred percent, and hepatitis B detected and controlled.
How can these risk ‘profiles’ be detected?
A routine blood test in patients with diabetes, obesity, high blood pressure, dyslipidemia, or an immune-mediated disease can find out whether or not they are at risk of developing liver fibrosis. The same goes for people who consume alcohol. According to WHO recommendations, it is necessary to rule out liver disease in men who consume more than 24g per day and more than 16g in women. By stopping alcohol consumption, eating a healthy diet, exercising, and receiving treatment for viral hepatitis, we can completely change the prognosis. And it is that right now liver diseases continue to be a cause of death that is growing. That is why a strategy is needed that combines all these criteria. On the one hand, prevention and, on the other hand, diagnosis and intervention that allows change.
“As a hepatologist, I want to make it clear that a person with liver disease should not drink even a drop of alcohol. Regarding the rest of society, it must be clear that alcohol is a very important cause of liver disease capable of producing many alterations in the body.
Why does a strong alcohol culture continue to exist in Spain?
We have fully introduced alcohol into our culture and we use it for everything. There are even messages that have been conveyed that alcohol is beneficial in certain aspects. We must change ‘the chip’ of this society. As a hepatologist, I want to make it clear that a person with liver disease should not drink even a drop of alcohol. Regarding the rest of society, it must be clear that alcohol is a very important cause of liver disease capable of producing many alterations in the body. There is always a complex debate between health and the economy and in the case of alcohol this is the case. From the point of view of liver health, we claim that a person at risk should have a routine test to find out if he is sick or not.
“The problem lies in how difficult it is to ensure that only one drink of the day is taken”
Much has been said that a glass of wine a day is good…
There are many nuances. You have to see the size of the cup, that it really is only one… According to some studies, in certain situations it could be beneficial. The problem lies in how difficult it is to ensure that only one drink of the day is taken… that is why we cannot recommend it.
“When a patient with stage B or C hepatocellular carcinoma progresses with angiogenesis inhibitor treatment and an immunomodulator, we have to consider what the therapeutic ladder for hepatocellular carcinoma really is and ensure access to these drugs”
What is the current situation of liver cancer in Spain?
Liver cancer continues to grow because we are immersed in a pandemic of liver diseases that is closely related to changes in lifestyle, sedentary lifestyle, obesity, not moving… All liver diseases will cause liver damage and progress to cirrhosis; even lead to cancer. However, patients can also develop cancer without previously suffering from cirrhosis, which makes detection difficult because until 10 years ago, patients at risk were those with cirrhosis.
What is the current approach to this tumor like?
Regarding treatment, there is the possibility of performing surgery for small cases or liver transplantation, although there are a low percentage of those who can benefit from a transplant. The following options are radiofrequency therapies, chemoembolization or radioembolization to finally reach systemic treatment. Immunotherapy is currently being administered in conjunction with antiangiogenic drugs. However, the problem lies in the second line: when a patient with stage B or C hepatocellular carcinoma with an angiogenesis inhibitor treatment and an immunomodulator progresses or does not respond, we have to consider what the therapeutic ladder of hepatocellular carcinoma really is and ensure access to these drugs by hepatologists and patients.
“At the present time we must better draw the scenario and the therapeutic ladder for the patient with hepatocarcinoma because it is a highly aggressive neoplasm that we have to try to address in the best possible way “
What is the problem of access to the second line in Spain?
Currently second-line drugs are not financed in Spain. For many years our first line was sorafenib, until lenvatinib also arrived with similar results. Then came the study that showed that the combination of an antiangiogenic drug with an immunomodulator improved outcomes.. However, the problem starts on the second line; which we dragged from that we used sorafenib. We did not have approved second-line therapies according to the needs of the patients. At the present time we must better outline the scenario and the therapeutic ladder for the patient with hepatocarcinoma because it is a highly aggressive neoplasm that we have to try to address in the best possible way.. Sandra Pulido (GM)
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