Liver Disease Education and Public Health

Introduction

Chronic liver disorders (CLDs) pose a significant global public health challenge. The liver holds significant implications for an individual's overall well-being and should assume a pivotal position in global public health strategies. Presently, there is a global prevalence of chronic lung diseases (CLDs) that is likely underestimated despite their significant impact on mortality rates annually. This phenomenon can be juxtaposed with other significant public health issues pertaining to chronic ailments, such as diabetes, respiratory disorders, and cardiovascular diseases. However, in contrast to other chronic diseases, a significant number of chronic liver disorders (CLDs) can be effectively cured, avoided, or managed by appropriate treatment interventions.

Viral, alcohol-induced chronic liver disease (ALD) and emerging metabolic chronic liver diseases (such as non-alcoholic fatty liver disease, NAFLD, and non-alcoholic steatohepatitis, (NASH) have been largely overlooked as significant public health concerns in many countries. Immediate measures are important to address the prevention, diagnosis, proper management, and treatment of chronic liver diseases (CLDs). In order to achieve this objective, it is imperative to implement extensive screening measures for chronic liver disease (CLD). The achievement of this objective relies heavily on the imperative of public knowledge and engagement by healthcare systems and authorities.

What Is the Status of Liver Disease as a Neglected Public Health Issue?

The global public health burden of CLDs, regardless of source, is unknown and almost definitely underestimated.

• A reliable assessment of the rate and frequency in large regions is lacking, particularly in places where CHC is extremely prevalent, as well as in regions with a high risk of ALD or NASH.

• Furthermore, an accurate global assessment of the impact of CLDs, particularly the death and disability rates associated with decompensated liver disease and HCC, is required.

• All types of CLD, but especially for NASH, a new CLD that is causing an increase in cirrhosis and HCC, and for which there are no precise indicators for screening.

Although some nations have implemented national CHC programs, most do not, including the areas with the highest occurrence.

• There are HBV (hepatitis B virus) vaccine programs all throughout the world, but their effectiveness has yet to be determined. Given that practically all cases of CHB are transmitted from mother to infant, the recommended method of vaccinating neonates at birth should be expanded and implemented. There are currently no national or worldwide programs for NASH due to a lack of a clear diagnostic and management approach, as well as a lack of particular medications.

• The actual issue is a lack of public and governmental knowledge of the magnitude of CLDs' public health burden. However, early diagnosis would undoubtedly be cost-effective because it allows for optimal therapy and/or delivery of existing medications that can prevent cirrhosis and HCC. Increasing easy access to antiviral medication is obviously critical for CHB and CHC.

What Emergency Actions Are Required?

• The primary focus should be on enhancing awareness regarding chronic lung diseases (CLDs) among the general population, healthcare professionals, and governmental authorities.

• The dissemination of knowledge regarding the prevalence and etiology of chronic lung diseases (CLDs) should be extensively propagated. The development of chronic lung diseases (CLDs) is understood to be influenced by the interplay of various contributing factors.

• Furthermore, the presence of HIV co-infection has been observed to expedite the advancement of chronic hepatitis B (CHB) and chronic hepatitis C (CHC) unless appropriate treatment measures are implemented.

• Various factors, including cultural, socioeconomic, environmental, psychological, and lifestyle factors, significantly contribute to the development of certain liver diseases, such as non-alcoholic steatohepatitis (NASH), chronic hepatitis B (CHB), and chronic hepatitis C (CHC).

• Among these aspects, excessive alcohol intake is particularly influential. It is imperative to provide the public with education regarding the potential consequences associated with specific behaviors that elevate the likelihood of developing chronic lung disease (CLD).

Undoubtedly, there exists a lack of public awareness regarding chronic lung diseases (CLDs) due to their asymptomatic nature and the delayed onset of symptoms. Physicians sometimes do not acknowledge the presence of CLDs due to the lack of observable symptoms, unremarkable clinical evaluations, and limited biochemical irregularities.

• Furthermore, the level of understanding of chronic liver diseases (CLDs), specifically their ability to interpret serological markers of chronic hepatitis B (CHB) and chronic hepatitis C (CHC), as well as biochemical markers indicating non-alcoholic steatohepatitis (NASH), is suboptimal.

• It is imperative to ensure that physicians are well informed about the prevalence of non-alcoholic steatohepatitis (NASH) among patients exhibiting clinical manifestations, including those of moderate severity, as well as the coexistence of metabolic syndrome, which may be incomplete, in individuals who are overweight, hypertensive, diabetic, or have dyslipidemia. There is a pressing need for the development of targeted therapeutic interventions for non-alcoholic steatohepatitis (NASH).

Is Liver Inflammation Considered a Significant Contributing Element in the Course of Diseases?

• Inflammation of the liver is the primary driving force behind the progression of CLD, regardless of the underlying cause. The primary cause of hepatocyte necrosis is inflammation, which is directly associated with the immune system's reaction to the target cells. The progression of fibrosis to cirrhosis and HCC is triggered by necroinflammation, which is the root cause of morbidity and mortality.

• The evaluation of CLDs throughout the course of the past years has primarily concentrated on the fibrosis stage; however, fibrosis is not the root cause.

• The essential function of necroinflammation, which is the most important step in the progression of CLD but has been nearly lost as a result of the availability of serum fibrosis tests or scores, which are simpler to use than liver biopsies, has been completely ignored.

• In CHB and CHC, it is known that necroinflammation is not connected with the amount of viral load, and it is also not correlated with the amount of alcohol intake in ALD or the quantity of fat in NASH.

• The prognosis of chronic liver disease (CLD) and the prescription for therapy are both determined by histological scores, which take into account the level of inflammation (activity) as well as the stage of fibrosis.

• The presence of inflammation (alcoholic hepatitis) is used to differentiate between non-progressive and progressive alcoholic liver disease (ALD). The presence of inflammation is what distinguishes non-progressive NAFLD from progressive NAFLD (NASH), which is a more severe form of the disease.

• In chronic liver disease (CLD), the degree of necroinflammation has been found to have a correlation with the stage of fibrosis and the disease's prognosis. The degree of necroinflammation is found to have a direct relationship with the stage of fibrosis that has developed in CHC patients.

• Necroinflammation is the driving force behind the evolution of CLD. The histological effect of antiviral therapies in CHB and CHC demonstrates this, as these treatments are related to the disappearance of necroinflammation and the regression of fibrosis, even in patients who already have cirrhosis.

• The inflammation brings an end to the fibrogenesis process and makes way for natural fibrolysis to take place. Therefore, inflammation should be the focus of treatment, and a deeper understanding of the processes responsible for the overactive immune response in various CLDs is required to design treatments that are more successful.

Conclusion

CLDs are a significant and undoubtedly underappreciated global public health issue. CLDs are pervasive and asymptomatic, resulting from multiple, sometimes interrelated causes. The distribution of these diseases' causes is slowly shifting, and within the next decade, the proportion of CLDs caused by viruses will almost undoubtedly decrease while the proportion of NASH will increase significantly. To prevent cirrhosis-related morbidity and mortality, effective global actions, including education, prevention, and early diagnosis for management and treatment, are urgently required. One’s role is to raise awareness among the general public, healthcare professionals, and public health authorities in order to encourage proactive policies for early, comprehensive management that will reduce the short- and long-term burden of these diseases on public health. CLDs satisfy all of the criteria for systematic screening. Necroinflammation is the main mechanism in the progression of CLDs; therefore, it must be detected early. ALT levels are a simple and inexpensive indicator of liver necroinflammation, and they could serve as the primary tool in this procedure.