Chronic Liver Diseases


 Acute Hepatic Failure


 Pediatric Liver Diseases

Chronic Liver Diseases

Chronic liver diseases are a major branch in hepatology and a huge problem for the worldwide health care systems. In the US, over 26,000 people die each year from chronic liver disease and cirrhosis. More than 350,000 people are hospitalized each year due to cirrhosis.

Viral Hepatitis - HBV and HCV

More than 350 million people worldwide are inflicted by Hepatitis B Virus and about 170 million by Hepatitis C. 20% of those patients with chronic viral hepatitis might develop liver cirrhosis which might end in the need of a liver transplantation (LTx).

Each year, about 35,000 Americans contract hepatitis C, which is a more frequent cause of chronic liver disease than hepatitis B in the US. Almost 4 million Americans have antibodies against HCV indicating infection or prior exposure, about 1 million people against HBV.

In many Asian countries, 10% (5-20%) of the population are HBV carriers and HBV is 50 to 100 times more infectious than HIV. More than 2/3 of HBV cases have no symptoms - or unrecognized symptoms - so most people who become chronically infected never know it.

Hepatocellular Carcinoma - HCC

HCC, the primary malignancy of the liver is one of the most common tumours worldwide. Most cases of HCC are secondary to either a viral hepatitis infection or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis).

20% of the chronic hepatitis patients have the risk of hepatocellular carcinoma (HCC). There are about 1 Million new cases each year worldwide and without medical treatment the death rate would be 100%. The standard treatment is liver resection, but it can only be used for 5-15% of the patients. Since other non-surgical techniques like ablation and chemotherapy offer 5-year-survival rates of 30-40%, an estimated 550,000 people each year die of liver cancer.

Outside of the West, the usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually deadly within 3 to 6 months. This is partially due to late presentation with large tumours, but also the lack of medical expertise and facilities.

360,000 deaths each year are from countries in Eastern Asia alone (China, Hong Kong, Japan, Korea), which makes liver cancer one of the top three causes of death by cancer in most of Asia. 60% of liver cancer in Asian Americans is caused by chronic hepatitis B virus infection.

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HIV-Co-Infection

More than 40 million people in the world are affected by HIV/AIDS. Approximately 10% of the HIV-infected population worldwide is also infected with hepatitis B. This figure may approach 20% in Southeast Asia and 5% in North America and Western Europe. If HIV is combined with a co-infection of HBV or HCV, this might have severe effects on the development of cirrhosis.

Alcoholic Liver Disease

Alcoholic liver disease is a fast growing problem that can take a similar path as viral hepatitis. Between 10 and 25 per cent of alcoholics develop cirrhosis, but some do not, because of genetic factors.

In the UK, alcohol kills about 22000 people every year. Deaths from liver cirrhosis are rising here faster than anywhere else in Europe due to the development of chronic liver diseases caused by alcohol. More than 2 million Americans suffer from alcoholic liver disease.

Drug induced Liver Damage

300 - 3000 cases of liver damage in otherwise healthy women occur each year in Germany, if not caught early by the doctor. In order to keep this risk as low as possible, today's birth control pills contain much less oestrogen than before.

NASH - Liver Diseases associated with Obesity and Type 2 Diabetes Mellitus

The fastest growing segment in hepatology is non-alcoholic steatohepatitis (NASH), the most extreme form of NAFLD (fatty liver disease), which is regarded as a major cause of cryptogenic cirrhosis of the liver. The reason for NASH is fat in the liver, which causes inflammation and damage to the liver cells. If left untreated, it can lead to cirrhosis.

NASH currently affects 2 to 5 percent of people in America; most cases are associated with obesity and type 2 diabetes mellitus.

Hemochromatosis

A hereditary disease characterized by improper dietary iron metabolism. The iron accumulation in the tissue can eventually cause organ damage, manifesting as liver failure and diabetes mellitus respectively. More than 1 million Americans (1-in-200 to 1-in-300) are infected, the rate in Caucasians is estimated to be up to 5%. In Great Britain the number is estimated to be roughly one in every 300-400 people.

Wilson's Disease

An autosomal recessive disorder, with a male preponderance. Its main feature is accumulation of copper in tissues, which manifests itself with neurological symptoms and liver disease.The estimated heterozygous carrier rate is about 1 in 100, approximately 1 per 30,000 people in the US suffer from Wilson disease.

Primary Biliary Cirrhosis

An autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts within the liver. When these ducts are damaged bile builds up in the liver (cholestasis) and over time damages the tissue. This can lead to scarring, fibrosis, cirrhosis, and ultimately liver failure.

In 1996 there were 9,232 cases of primary biliary cirrhosis in the USA, the sex ratio being 9 to 1, women to men

Chronic Liver Diseases

  • infectious liver disease (HBV, HCV, HDV)
  • toxic-chronic (alcoholic)
  • NASH
  • co-infection (HBV+HIV)
  • toxic-chronic (drug induced)
  • autoimmune (PBC, chronic-active autoimmune hepatitis)
  • metabolic (hemochromatosis, Wilson's disease)
  • biliary (cholestasis; SecondaryBiliaryCirrhosis)
  • vasculary (heart failure)
  • other chronic (participation of liver in Crohn's, ulcerative colitis, Tuberculosis etc.)
  • kryptogenic symptoms (suspected fibrosis / cirrhosis)

Contact us regarding "Chronic Liver Diseases"
or call Tilo Stolzke at +49 451 400 83 01 directly.

Studies and Publications on Chronic Liver Disease

  • “Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study” Alcohol; Volume 42, Issue 8, Pages 675-682 Authors: I.A. Kirpich, N.V. Solovieva, S.N. Leikhter, N.A. Shidakova, O.V. Lebedeva, P.I. Sidorov, T.A. Bazhukova, A.G. Soloviev, S.S. Barve, C.J. McClain, M. Cave
  • J&J, FDA warn of liver risk with HIV drug Prezista. more...
  • Silibinin infusion has antiviral effect against HCV in nonresponders. more...



Chronic Liver Disease

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